Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis.

Abstract

Chronic rhinosinusitis (CRS) affects more than 10% of the population in the United States and Europe. Recent findings point to a considerable variation of inflammatory subtypes in patients with CRS with nasal polyps and patients with CRS without nasal polyps. According to current guidelines, glucocorticosteroids and antibiotics are the principle pharmacotherapeutic approaches; however, they fail in a group of patients who share common clinical and laboratory markers. Several clinical phenotypes often leading to uncontrolled disease, including adult nasal polyposis, aspirin-exacerbated respiratory disease, and allergic fungal rhinosinusitis, are characterized by a common endotype: a TH2 bias is associated with a higher likelihood of comorbid asthma and recurrence after surgical treatment. As a consequence, several innovative approaches targeting the TH2 bias with humanized mAbs have been subjected to proof-of-concept studies in patients with CRS with nasal polyps with or without comorbid asthma: omalizumab, reslizumab, mepolizumab, and recently dupilumab. Future concepts using upstream targets, such as GATA-3, also focus on this endotype. This current development might result in advantages in the treatment of patients with the most severe CRS.

• Authors: Claus Bachert, Luo Zhang, Phillippe Gevaert
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 136 Issue 6 Pg. 1431-1440 (Dec 2015) ISSN: 1097-6825 [Electronic] United States
• PMID: 26654192 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Humanized
• DNA, Catalytic
• GATA3 Transcription Factor
• GATA3 protein, human
• Aspirin

Topics

• Adult
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Aspirin (adverse effects)
• Asthma (epidemiology)
• Comorbidity
• DNA, Catalytic (therapeutic use)
• Drug Hypersensitivity (epidemiology)
• GATA3 Transcription Factor (immunology)
• Humans
• Lactococcus lactis (genetics)
• Nasal Polyps (drug therapy, epidemiology, immunology, surgery)
• Organisms, Genetically Modified
• Rhinitis (drug therapy, epidemiology, immunology, surgery)
• Sinusitis (drug therapy, epidemiology, immunology, surgery)