Biologics as Treatment for Sinusitis
Updated: Aug 23, 2019
Chronic sinusitis, also known as Chronic Rhinosinusitis (CRS) is a common condition that Otolaryngologists treat.
As a Rhinologist it is one of the top conditions I treat on a regular basis.
For decades the treatment options for CRS have not changed much. Common treatments have included saline (salt water) rinses, steroids applied directly into the nose (topical nasal steroids) and oral steroids (e.g. prednisone). While there are other treatments used in specific circumstances, in general, when these three treatment modalities aren't enough, patients are then typically offered surgery. After surgery, patients continue with medical therapies (saline rinses, topical steroids and when needed oral steroids). If symptoms get worse again then revision surgery may be required.
Biologic treatments may be positioned to disrupt the treatment paradigm in the near future.
If you haven't heard of biologic therapy as a treatment for sinusitis, it's likely because these treatments are relatively new. Only recently has the FDA actually approved a biologic treatment specifically for CRS. In June 2019 Dupilumab (sold under the trade name, Dupixent) was approved for use in patients with CRS with Polyps. This medication was initially approved by the FDA in March 2017, but only for patients with eczema.
Generally speaking biologic therapies are a wide group of medications that originate from living organisms. They are created from a variety of products such as vaccines, blood components, gene therapy and recombinant proteins The various biologic agents all target a component of the immune system that is known to impact the disease of interest.
In the case of Dupilumab, the target is a class of immune globulins involved in allergic reactions (IgE). IgE plays an important role in the development of eczema and CRS with Polyps, which is why it is effective for these conditions.
There are other biologic treatments that have been shown to be helpful for patients with CRS and polyps, but they are not yet approved by the FDA for use specifically for CRS. For example, Omalizumab (trade name Xolair), Mepolizumab (trade name Xolair) and Reslizumab (trade name Cinqair) are approved for use in patients with asthma. There are research studies that that suggest they can be effective for CRS with Polyps in patients that also have asthma. With the recent approval of Dupilumab for treating sinusitis with polyps there is reason for optimism that some of these treatments may follow in the future.
Since these treatments are all relatively new there is debate as to what role they will play in the treatment of sinusitis. At this time most rhinologists expect that biologics will compliment existing medical and surgical therapies rather than replace them, but as new therapies emerge over time it is certainly possible that could change.