A patient with chronic rhinosinusitis with nasal polyps has failed maximal medical therapy (topical steroids, saline irrigation). According to current guidelines (EPOS 2020), the definition of 'difficult-to-treat' CRS includes patients who have undergone adequate FESS and still remain symptomatic. Which biological agent is currently approved for CRS with nasal polyposis?
- A Omalizumab (anti-IgE)
- B Mepolizumab (anti-IL-5)
- C Dupilumab (anti-IL-4Rα, blocking IL-4 and IL-13 signalling) ✓
- D Benralizumab (anti-IL-5Rα)
Explanation
Dupilumab (an anti-IL-4Rα monoclonal antibody that simultaneously blocks IL-4 and IL-13 signalling) is the first and most strongly evidence-based biologic approved for CRS with nasal polyposis (CRSwNP) after inadequate response to corticosteroids. Multiple RCTs (LIBERTY NP SINUS-24 and SINUS-52) demonstrated significant reduction in polyp size, nasal congestion, and smell disturbance. Omalizumab has also shown efficacy in CRSwNP but dupilumab is the primary approved agent. Mepolizumab and benralizumab target the IL-5 pathway and have evidence mainly in eosinophilic asthma.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.