Current and emerging biological therapies for Chronic rhinosinusitis with nasal polyps with type 2 inflammation

ABSTRACT

Introduction

Chronic rhinosinusitis with nasal polyps (CRSwNP), especially CRSwNP with type 2 inflammation, remains the most difficult-to-treat subtype with high prevalence worldwide. The emergence of biologics has the potential to fulfill the unmet medical needs of patients with CRSwNP driven by type 2 inflammation.

Areas covered

A current review of the literature was performed to overview current and emerging biological therapies in the treatment of CRSwNP.

Expert opinion

In an era of precision medicine, biologics have been given expectations to provide customized therapies to patients with CRSwNP, particularly those with refractory CRSwNP. Large clinical trials and real-world experiences are both essential for the application of biologics. Moreover, to make biological therapy more tailored to patients, an in-depth understanding of the different mechanisms of biologics, further elucidating the relationship between biologics and conventional medical and surgical treatments, and identifying predictive biomarkers warrant thorough investigations.

KEYWORDS:

• Biologics
• chronic rhinosinusitis with nasal polyps (CRSwNP)
• monoclonal antibody
• refractory
• type 2 inflammation

Article highlights

• CRSwNP is a heterogeneous disease that might not be adequately controlled by the conventional ‘one-size-fits-all’ treatment strategy thereby urging the implementation of novel biologics to fulfill medical needs.

• Biologics targeting type 2 inflammations are efficacious in the treatment of CRSwNP. Currently, dupilumab, omalizumab, mepolizumab, benralizumab, and CM310 have demonstrated efficacy or potential in treating CRSwNP.

• The identification and application of biomarkers that can predict patients’ response to biologics will be of great importance in guiding accurate biological therapy selection and providing customized treatment to each individual.

• Unapproved biological therapies will need additional double-blind registration trials to further verify their efficacy and safety. While the approved products will benefit from RCTs of larger cohorts and longer treatment and follow-up periods, real-world experience, and comparison with surgery to fulfill the efficacy-effectiveness gap.

Declaration of interest

The authors declare no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Figures were created by Figdraw software (www.figdraw.com).

Additional information

Funding

This work was supported by grants from the national key R&D program of China (2022YFC2504100); National Natural Science Foundation of China (81900917, 82171108, 82025010, and 81870698); Changjiang Scholars and Innovative Research Team (IRT13082); CAMS Innovation Fund for Medical Sciences (2019-I2M-5-022); Beijing Municipal Science and Technology Project (Z181100001618002 and Z211100002921057); Capital’s Funds for Health Improvement and Research (CFH2022-1-1091); Beijing Municipal Administration of Hospitals’ Mission Plan (SML20150203); Beijing Municipal Administration of Hospitals’ Dengfeng plan (DFL20190202), and Dongcheng District Outstanding Talent Nurturing Program (2022-dchrcpyzz-3).