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      Novel Treatments for Chronic Rhinosinusitis

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          ABSTRACT

          As we move into the era of personalized medicine, there has been considerable progress made toward an increasingly sophisticated understanding of chronic rhinosinusitis. Precise understanding of the pathophysiology and natural history of the disease has unlocked a novel range of therapeutic options, both medical and surgical. This literature review aims to appraise some of these developments, including the utility of monoclonal antibodies, office based procedures such as balloon sinuplasty and steroid-eluting stents, and adjuncts to surgery such as image guidance. In reviewing the evidence for these novel interventions we aim to provide an insight to the tools which may become commonplace in the arsenal of the rhinologist of the future.

          How to cite this article

          Hopkins C, Walker A. Novel Treatments for Chronic Rhinosinusitis. Int J Head Neck Surg 2018;9(1):15-20.

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          Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial.

          Claus Bachert, Leda Mannent, Robert M Naclerio … (2016)
          Dupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases.
          Article 0 comments Cited 235 times – based on 0 reviews     Review now
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            Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma.

            De Dirk Bacquer, P Cauwenberge, Courtney Blomme … (2012)
            Adult patients with nasal polyps often have comorbid asthma, adding to the serious effect on the quality of life of these patients. Nasal polyps and asthma might represent a therapeutic challenge; inflammation in both diseases shares many features, such as airway eosinophilia, local IgE formation, and a T(H)2 cytokine profile. Omalizumab is a human anti-IgE mAb with proved efficacy in patients with severe allergic asthma. Omalizumab could be a treatment option for patients with nasal polyps and asthma. The goal of this study was to investigate the clinical efficacy of omalizumab in patients with nasal polyps and comorbid asthma. A randomized, double-blind, placebo-controlled study of allergic and nonallergic patients with nasal polyps and comorbid asthma (n = 24) was conducted. Subjects received 4 to 8 (subcutaneous) doses of omalizumab (n = 16) or placebo (n = 8). The primary end point was reduction in total nasal endoscopic polyp scores after 16 weeks. Secondary end points included a change in sinus computed tomographic scans, nasal and asthma symptoms, results of validated questionnaires (Short-Form Health Questionnaire, 31-item Rhinosinusitis Outcome Measuring Instrument, and Asthma Quality of Life Questionnaire), and serum/nasal secretion biomarker levels. There was a significant decrease in total nasal endoscopic polyp scores after 16 weeks in the omalizumab-treated group (-2.67, P = .001), which was confirmed by means of computed tomographic scanning (Lund-Mackay score). Omalizumab had a beneficial effect on airway symptoms (nasal congestion, anterior rhinorrhea, loss of sense of smell, wheezing, and dyspnea) and on quality-of-life scores, irrespective of the presence of allergy. Omalizumab demonstrated clinical efficacy in the treatment of nasal polyps with comorbid asthma, supporting the importance and functionality of local IgE formation in the airways. Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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              Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease.

              Nan Zhang, Thibaut Van Zele, Claudina A Pérez-Novo … (2008)
              Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by the accumulation of inflammatory cells; however, an eosinophil predominance is seen in white (Belgian), but not Asian (south Chinese), patients with polyps. We sought to investigate the association of inflammatory cell predominance with regulatory T-cell and T-effector cell patterns. Nasal mucosal tissue was obtained from 26 consecutive Belgian patients with CRSwNP and 21 Belgian control subjects and 29 south Chinese patients with CRSwNP and 29 south Chinese control subjects, who all underwent phenotyping, including nasal endoscopy and computed tomographic scanning. Tissues were investigated for granulocytes and their products and T-effector/regulatory T cells and related cytokines. Both CRSwNP groups were comparable in terms of symptoms, computed tomographic scan results, and nasal endoscopy results, but asthma comorbidity was significantly higher in white patients. Tissue from white patients with CRSwNP was characterized by eosinophilic inflammation (eosinophil cationic protein/myeloperoxidase ratio > 2), whereas samples from Asian patients were biased toward neutrophilic inflammation (eosinophil cationic protein/myeloperoxidase ratio = 0.25). Both CRSwNP groups demonstrated significant upregulation of the T-cell activation marker soluble IL-2 receptor alpha and significant downregulation of Foxp3 expression and TGF-beta1 protein content versus their respective control groups. However, whereas white patients displayed a significant increase in T(H)2 cytokine and related marker levels versus control subjects and versus Asian patients, the latter showed a T(H)1/T(H)17 cell pattern versus control tissue. Nasal polyps (CRSwNP) from white and Asian patients are both characterized by T-cell activation and impaired regulatory T-cell function; however, T-effector cells in the samples from white patients were T(H)2-biased, whereas samples from their Asian counterparts demonstrated a T(H)1/T(H)17 polarization.
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                Author and article information

                Contributors
                Claire Hopkins: Role: Professor
                Abigail Walker: Role: Professor
                Journal
                Journal ID (publisher): IJHNS
                Title: International Journal of Head and Neck Surgery
                Abbreviated Title: IJHNS
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Print): 0975-7899
                ISSN (Electronic): 0976-0539
                Publication date (Print): January-March 2018
                Volume: 9
                Issue: 1
                Pages: 15-20
                Affiliations
                [1,2 ] Department of ENT, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
                Author notes
                Claire Hopkins, Professor, Department of ENT Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK, e-mail: clairehopkins@ 123456yahoo.com
                Article
                DOI: 10.5005/jp-journals-10001-1331
                SO-VID: 9a159e0c-b6b0-42b3-9b1f-ba7d30e9f40e
                Copyright © Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.
                License:

                Creative Commons Attribution 4.0

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                Subject: REVIEW ARTICLE
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                file-pdf ijhns-2018-9-15.pdf

                ScienceOpen disciplines: General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                Keywords: Chronic rhinosinusitis,Robotic surgery,Monoclonal antibodies,Sinus,Nasal polyposis
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                ScienceOpen disciplines: General medicine, Pathology, Surgery, Sports medicine, Anatomy & Physiology, Orthopedics
                Keywords: Chronic rhinosinusitis, Robotic surgery, Monoclonal antibodies, Sinus, Nasal polyposis

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