A 35-year-old with chronic rhinosinusitis with nasal polyps (CRSwNP) unresponsive to intranasal corticosteroids and two courses of surgical FESS is being considered for biologic therapy. The current first-line approved biologic for CRSwNP targets which cytokine pathway?
- A IL-5 pathway (benralizumab/mepolizumab)
- B IgE pathway (omalizumab only)
- C TNF-alpha pathway (adalimumab)
- D IL-4/IL-13 receptor (dupilumab) ✓
Explanation
Dupilumab (anti-IL-4 receptor alpha monoclonal antibody, blocking both IL-4 and IL-13 signaling) is the first biologic approved for severe chronic rhinosinusitis with nasal polyps (CRSwNP) in patients who are inadequately controlled despite systemic corticosteroids and/or surgery (approved FDA 2019, EMA 2019, and India). IL-4 and IL-13 drive type 2 (Th2) inflammation, eosinophil recruitment, and IgE production underlying CRSwNP pathogenesis. Omalizumab (anti-IgE) is also approved for CRSwNP. Benralizumab (anti-IL-5 receptor alpha) is approved for eosinophilic asthma and has evidence in CRSwNP. TNF-alpha blockers have no role in CRSwNP.
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.