抽象的な
Biologics for the treatment of severe chronic rhinosinusitis with nasal polyps
Nightingale Syabbalo
Chronic rhinosinusitis is a heterogenous persistent inflammatory disease affecting the nasal and paranasal sinuses. It is classified into chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). CRSwNP is strongly associated with eosinophilic asthma and aspirin exacerbated respiratory disease. CRSwNP is a debilitating disease, with significant clinical burden and contributes significantly to the socioeconomic costs of the health care systems. The comorbidity of CRSwNP and asthma is difficult to treat, because CRSwNP impacts on the severity of asthma. Similarly, asthma contributes to the morbidity and severity of CRSwNP, which may necessitate high-dose intranasal corticosteroids and repeated revision functional endoscopic sinus surgery in patients with CRSwNP. Type 2 helper (Th2) lymphocytes 2 and innate group 2 cells (ILC2s) play a central role in the pathogenesis of both eosinophilic asthma and CRSwNP via secretion of inflammatory cytokines and chemokines. Cytokines secreted by Th2 lymphocytes and ILC2s, such as IL-5, IL-4, IL-13 and epithelialderived cytokines including IL-25, IL-33 and thymic stromal lymphopoietin (TSLP) play a key role in the pathogenesis of eosinophilic asthma and CRSwNP. Uniform targeted treatment of asthma and CRSwNP may require administration of anti-interleukin biologics. Dupilumab and omalizumab are the only biologics which have been approved for the treatment of both diseases. They have been shown to significantly improve patient-reported nasal congestion scores, nasal polyp scores, Lund-Mackay computed tomography scores, peak nasal inspiratory flow and the Sino-Nasal Outcome Test-22 scores. Mepolizumab, reslizumab and benralizumab (anti-IL-5) and tezepelumab (anti-TSLP) are in phase III clinical trials. They have been shown to be effective and safe; and well tolerated for the treatment of patients with eosinophilic asthma and CRSwNP.