What Are The Most Effective Treatment Options For Patients With Refractory Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) Who Have Failed To Respond To Standard Therapies, Including Oral Corticosteroids And Intranasal Corticosteroids, And Are Now Candidates For Biologic Therapy With Agents Such As Dupilumab Or Benralizumab?

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For patients with refractory chronic rhinosinusitis with nasal polyps (CRSwNP) who have not responded to standard corticosteroid therapies, biologic agents such as dupilumab and benralizumab represent the most effective treatment options. Here's a structured summary of the approach:

  1. Biologic Therapy:

    • Dupilumab: Targets IL-4 and IL-13, key cytokines in allergic inflammation. It is administered subcutaneously every two weeks. Dupilumab is beneficial for patients with comorbid conditions like asthma or atopic dermatitis, as it addresses multiple inflammatory pathways.
    • Benralizumab: Targets IL-5, affecting eosinophilic inflammation. It is given subcutaneously every four weeks after initial doses. Benralizumab is particularly effective in patients with high eosinophil levels, indicating a strong eosinophilic component in their CRSwNP.

  2. Efficacy and Considerations:

    • Both biologics have demonstrated significant reduction in nasal polyp size and improvement in quality of life in clinical trials. The choice between them may depend on patient-specific factors, including comorbidities and the underlying inflammatory profile.

  3. Alternative Treatments:

    • Surgery: Considered for patients with significant nasal obstruction, often used alongside medical therapy to manage recurrence.
    • Aspirin Desensitization: Appropriate for patients with Samter's triad, a specific subgroup with asthma and aspirin sensitivity.
    • Antibiotics and Immunotherapy: Limited to cases with bacterial infection or allergic etiology, respectively.

  4. Considerations:

    • Cost and administration frequency of biologics may influence treatment decisions.
    • Both dupilumab and benralizumab are supported by robust clinical evidence, making them the preferred options for targeted therapy in refractory CRSwNP.

In conclusion, dupilumab and benralizumab are the primary biologic treatments for refractory CRSwNP, offering targeted therapy based on the patient's inflammatory profile and comorbid conditions. Additional treatments like surgery may be considered in specific cases but are secondary to biologic therapy.