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Cause And Symptoms

Complications

Diagnosis And Treatment

Overview

Prevention

References

chronic-rhinosinusitis-with-nasal-polyps-crswnp

Chronic Rhinosinusitis With Nasal Polyps CRSWNP

<h3 style="text-align:center;">Chronic rhinosinusitis with nasal polyps (CRSwNP):</h3>

<h3 style="text-align:center;">A chronic type 2 inflammatory disease of the nasal/paranasal sinuses of the upper airway characterized by rhinosinusitis and bilateral nasal polyps1,2</h3>

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 <h3 style="text-align:center;">&nbsp; Type 2 inflammation drives disease pathology in up to 87% of patients with CRSwNP4</h3></td>
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 <h3 style="text-align:center;">Loss of smell may be used as a diagnostic symptom and may predict CRSwNP patients with poor long-term outcomes requiring approaches beyond the standard of care</h3></td>
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 <h3 style="text-align:center;">&nbsp;&nbsp;&nbsp; Type 2 inflammation in CRSwNP is associated with loss of smell</h3></td>
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*Clinical consequences are listed in descending order based on patient questionnaire: “Please mark the most important items affecting your health.” †Loss of smell is included in CRSwNP diagnostic criteria in the following international guideline publications: EPOS 2020, ICAR:RS 2021, EUFOREA 2021, and EAACI 2021. CRSwNP, chronic rhinosinusitis with nasal polyps; EAACI, European Academy of Allergy and Clinical Immunology; EPOS, European Position Paper on Rhinosinusitis and Nasal Polyps; EUFOREA, European Forum for Research and Education in Allergy and Airway Diseases; ICAR:RS, International Consensus Statement on Allergy and Rhinology: Rhinosinusitis; IL, interleukin; SCS, systemic corticosteroids; SOC, standard of care. 1. Fokkens WJ, et al. Rhinology. 2020;58(suppl S29):1-464. 2. Schleimer RP. Annu Rev Pathol. 2017;12:331-357. 3. Mullol J, et al. J Allergy Clin Immunol Pract. 2022;10(4):1086-1095.e5. 4. Stevens WW, et al. J Allergy Clin Immunol Pract. 2019;7(8):2812-2820. 5. Kato A. Allergol Int. 2015;64(2):121-130. 6. Gandhi NA, et al. Nat Rev Drug Discov. 2016;15(1):35-50. 7. Wise SK, et al. Int Forum Allergy Rhinol. 2014;4(5):361-370. 8. Takabayashi T, et al. J Allergy Clin Immunol. 2013;132(3):584-592.e4. 9. Chalermwatanachai T, et al. Sci Rep. 2018;8(1):7926. 10. Bachert C, et al. J Allergy Clin Immunol. 2021;147(1):29- 36. 11. Orlandi RR, et al. Int Forum Allergy Rhinol. 2021;11(3):213-739. 12. Agache I, et al. Allergy. 2021;76(1):14-44. 13. Rimmer J, et al. Cochrane Database Syst Rev. 2014;(12):CD006991. 14. Bakhshaee M, et al. Iran J Otorhinolaryngol. 2016;28(85):125-134. 15. Van Zele T, et al. J Allergy Clin Immunol. 2010;125:1069-1076.e4. 16. Seys SF, et al. Allergy. 2020;75(11):2867-2878.

CHRONIC-RHINOSINUSITIS-WITH-NASAL-POLYPS-CRSWNP

RHINOLOGY

Loss of Smell Is a Key Symptom in CRSwNP

<h2>Loss of Smell Improvement in Patients With CRSwNP: Results From SINUS-24 and SINUS-52a</h2>

These materials are presented by Sanofi and Regeneron Medical for scientific exchange purposes only. Please refer to the product label for full prescribing information. Figures were reproduced with permission from the publisher. *P&lt;0.05/**P&lt;0.01/***P&lt;0.001 /****Nominal P&lt;0.0001 vs placebo. aPlease see manuscripts for full details.1–3 bEligible patients were aged ≥18 years with bilateral nasal polyps and symptoms of CRS despite INCS therapy before randomization and had received SCS in the preceding 2 years (or had a medical contraindication or intolerance to SCS) or previous sinonasal surgery. In SINUS-24, patients were randomly assigned (1:1) to dupilumab 300 mg SC q2w or to matching placebo. In SINUS-52, patients were randomly assigned (1:1:1) to dupilumab 300 mg SC q2w for 52 weeks, the same schedule for the first 24 weeks followed by dupilumab 300 mg SC q4w, or placebo. cScale 0–3: Higher scores indicate greater disease severity. dPooled data from SINUS-24 and SINUS-52. e(n=724). fOnly the 710 patients who completed an UPSIT assessment at BL were included in this analysis. gNominal.hTwo deaths occurred during the study period that were deemed unrelated to the study drug; 1 patient given placebo in SINUS-24 had suspected myocardial infarction occurring after the period of TEAEs, and 1 treated with dupilumab in SINUS-52 had intracranial hemorrhage after a fall, occurring within the period of TEAEs. These patients were not included in the safety population. iInjection site reactions cluster included injection site reaction, pain, bruising and swelling. jConjunctivitis cluster included conjunctivitis, allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, giant papillary conjunctivitis, eye irritation, and eye inflammation. BL, baseline; CRS, chronic rhinosinusitis; INCS, intranasal corticosteroids; LoS, loss of smell; LS, least-squares; LSMD, least-squares mean difference; q2w, every 2 weeks; q4w, every 4 weeks; SC, subcutaneously; SCS, systemic corticosteroids; SOC, standard of care; TEAE, treatment-emergent adverse event; UPSIT, University of Pennsylvania Smell Identification Test. 1. Bachert C, et al. Lancet. 2019;394:1638–1650. 2. Mullol J, et al. J Allergy Clin Immunol Pract. 2022;10:1086-1095.e5. 3. Hopkins C, et al. Int Forum Allergy Rhinol. 2021;11:1087–1101. 4. Dupixent (dupilumab) Prescribing Information. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; Tarrytown, NY: Regeneron Pharmaceuticals, Inc. 2024

<h2>Loss of Smell Improvement in Patients With CRSwNP: Real-World Dataa</h2>

These materials are presented by Sanofi and Regeneron Medical for scientific exchange purposes only. Please refer to the product label for full prescribing information.&nbsp; *P&lt;0.001/ **P&lt;0.0001. aPlease see manuscripts for full details.1–3 Note that real-world data are collected from diverse sources outside the controlled environment of a clinical trial. As such, the reliability of real-world data can be hindered by data quality issues, confounding variables, and limitations in establishing causality.4 bA phase 4 real-life, observational, retrospective, multicenter study that assessed the effectiveness and safety of dupilumab 300 mg SC q2w in patients with severe uncontrolled CRSwNP over the first year of treatment. Patients enrolled were treated between November 2020 and March 2022. cA real-world prospective observational study that included patients with CRswNP who underwent treatment with dupilumab. Patients were treated with dupilumab 300 mg SC q2w as an add-on therapy to INCS. The treatment period for this study wasnot specified in the manuscript. dAn observational, retrospective multicenter study. Patients were treated with dupilumab 300 mg SC q2w as an add-on therapy to INCS for ≥1 year and followed between February 2020 and November 2022. eData from different studies are not meant to be directly compared. Data reported are not comprehensive. fThe manuscript does not provide data on the statistical significance of the change from baseline to the specified timepoint. BL, baseline; INCS, intranasal corticosteroids; LoS, loss of smell; q2w, every 2 weeks; SC, subcutaneously; VAS, Visual Analogue Scale. 1. De Corso E, et al. Allergy. 2023;78:2669–2683. 2. Albrecht T, et al. World Allergy Organ J. 2023;16:100780. 3. Ottaviano G, et al. J Pers Med. 2023;13:234. 4. Kim HS, Kim JH. J Korean Med Sci. 2019;34(4):e28. 
 &nbsp;

Loss of Smell Improvement in Patients With CRSwNP

aNo positioning of biologics was discussed. bUncontrolled CRSwNP was defined as “patient-reported lack of control and the presence of clinically relevant sinonasal symptoms of active disease (defined as overall symptom severity, nasal obstruction, and smell).” cBecause of a lack of research evaluating control in patients with CRSwNP alone, no exact cutoff was provided for patient-reported control. Advisors recommended asking patients whether their individual symptoms were controlled or burdensome with a binary (yes/no) answer. dFor research purposes, symptoms were not considered clinically relevant/bothersome when a patient’s VAS score was ≤5 cm for a particular symptom, as a previous study showed that a VAS score of 5 cm for overall symptoms severity best distinguished between patients whose CRS symptoms affected their QOL. ePreferably evaluated by nasal endoscopy. fThere was no unanimous agreement on the length of an exacerbation, but a suggestion of 6 weeks maximum was accepted. gThe 2024 definition of treatment response emphasizes individual therapy optimization (evaluate alternative diagnosis, assess treatable traits, and consider salvage surgery or biologic switch) and provides reference values for criteria compared with the definition provided in 2023.1,2 CRS, chronic rhinosinusitis; CRSwNP, chronic rhinosinusitis with nasal polyps; EPOS, European Position Paper on Rhinosinusitis and Nasal Polyps; EUFOREA, European Forum for Research and Education in Allergy and Airways Diseases; HCP, healthcare professional; OCS, oral corticosteroids; QOL, quality of life; VAS, visual analog scale. 1. Fokkens WJ, et al. Rhinology. 2024. doi:10.4193/Rhin23.415. 2. Fokkens WJ, et al. Rhinology. 2023;61:194–202.

An expert panel convened by EPOS2020 and EUFOREA proposed standardized definitions for disease control, remission, and progression in CRSwNP. This initiative aims to harmonize and optimize the standard of care for patients with CRSwNP.

Chronic Rhinosinusitis With Nasal Polyps CRSWNP

Latest Articles

Loss of Smell Is a Key Symptom in CRSwNP

Loss of Smell Improvement in Patients With CRSwNP

EPOS2020/EUFOREA Expert Opinion on Defining Disease States and Therapeutic Goals in CRSwNP