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rhinosinusitis with nasal polyposis

Management: - nasal glucocorticoids (1st line treatment) - oral glucocorticoids for initially for 2 weeks - diminishes nasal polyp size for up to 28 weeks [1] - adverse effects include - adrenal suppression - increased bone turnover - early & transient benefits of oral glucocorticoids probably do not outweigh their potential adverse effects [2] - dupilumab (Dupixent) add-on therapy for nasal polyposis insufficiently responsive to nasal glucocorticoids (FDA-approved >= 12 years) [11] - most patients respond within 16 weeks [12] - mepolizumab (Nucala) reduces both polyp size & need for surgery [5] - omalizumab of benefit [6] - benralizumab may be of benefit [7] - antifungal agents may be useful in cases of allergic fungal rhinosinusitis with nasal polyposis [9] - endoscopic sinus surgery - good short-term relief, but minimally effective at 1 year for patients [8]

General

rhinosinusitis nasal polyposis

References

  1. Vaidyanathan S et al Treatment of Chronic Rhinosinusitis With Nasal Polyposis With Oral Steroids Followed by Topical Steroids: A Randomized Trial Annals of Internal Medicine 2011, 154:293-302 http://www.annals.org/content/154/5/293.abstract - Mullol J and Alobid I Combined Oral and Intranasal Corticosteroid Therapy: An Advance in the Management of Nasal Polyposis Annals of Internal Medicine 2011, 154:154:365-367 http://www.annals.org/content/154/5/365.extract
  2. Mullol J and Alobid I. Combined oral and intranasal corticosteroid therapy: An advance in the management of nasal polyposis? Ann Intern Med 2011 Mar 1; 154:365. PMID: 21357913
  3. FDA News Release. June 26, 2109 FDA approves first treatment for chronic rhinosinusitis with nasal polyps. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-chronic-rhinosinusitis-nasal-polyps
  4. Hopkins C Chronic Rhinosinusitis with Nasal Polyps. N Engl J Med 2019; 381:55-63. July 4, 2019 PMID: 31269366 https://www.nejm.org/doi/full/10.1056/NEJMcp1800215 - Rothaus C Chronic Rhinosinusitis with Nasal Polyps. NEJM Resident 360. July 3, 2019. https://resident360.nejm.org/clinical-pearls/chronic-rhinosinusitis-with-nasal-polyps
  5. Boyles S Mepolizumab Offers Relief for Chronic Sinus Trouble - Anti-IL5 biologic cut polyp size, need for surgery in chronic rhinosinusitis with nasal polyps. MedPsge Today. Sept 10, 2020 https://www.medpagetoday.com/meetingcoverage/ers/88539 - Hopkins C et al Add-on mepolizumab for chronic rhinosinusitis with nasal polyps: SYNAPSE study European Respiratory Society International Congress (ERS 2020)
  6. Gevaert P et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. Allergy Clin Immunol 2020 Sep; 146:595 PMID: 32524991 Free article https://www.jacionline.org/article/S0091-6749(20)30752-1/fulltext
  7. Reuters Staff AstraZeneca's Asthma Drug Succeeds Late-Stage Nasal Polyposis Study. Medscape - Sep 10, 2020. https://www.medscape.com/viewarticle/937161
  8. Lourijsen ES et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: A multicentre, randomised, controlled trial. Lancet Respir Med 2022 Apr; 10:337. PMID: 35012708 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00457-4/fulltext
  9. Archer SM, Meyers AD Nonsurgical Treatment of Nasal Polyps.. Medscape. April 1, 2021 https://emedicine.medscape.com/article/861353-treatment
  10. Kwah JH, Peters AT. Nasal polyps and rhinosinusitis. Allergy Asthma Proc. 2019;40:380-4. PMID: 31690375
  11. Ingram I First Drug OK'd for Chronic Rhinosinusitis With Nasal Polyps in Adolescents/ Dupilumab lands expanded indication for upper airway disease. MedPage Today September 17, 2024 https://www.medpagetoday.com/pulmonology/generalpulmonary/111997
  12. Bachert C, Khan AH, Fokkens WJ et al. Dupilumab response onset, maintenance, and durability in patients with severe CRSwNP. J Allergy Clin Immunol. 2024 Aug 14:S0091-6749(24)00820-0. PMID: 39151476 Free article https://www.jacionline.org/article/S0091-6749(24)00820-0/fulltext