Positionspapier: Anwendung von Biologika bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC)

L. Klimek; U. Förster-Ruhrmann; S. Becker; A. Chaker; S. Strieth; T. K. Hoffmann; S. Dazert; T. Deitmer; H. Olze; A. Glien; S. Plontke; H. Wrede; W. Schlenter; H. J. Welkoborsky; B. Wollenberg; A. G. Beule; C. Rudack; M. Wagenmann; T. Stöver; T. Huppertz; J. Hagemann; C. Bachert

doi:10.1055/a-1197-0136

Laryngo-Rhino-Otologie, Inhaltsverzeichnis

Laryngorhinootologie 2020; 99(08): 511-527
DOI: 10.1055/a-1197-0136

Leitlinien und Empfehlungen

Positionspapier: Anwendung von Biologika bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC)

L. Klimek

¹Zentrum für Rhinologie und Allergologie, Wiesbaden

,

U. Förster-Ruhrmann

²Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Charité, Berlin

,

S. Becker

³Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen

,

A. Chaker

⁴Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München

,

S. Strieth

⁵Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn

,

T. K. Hoffmann

⁶Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm

,

S. Dazert

⁷Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum

,

T. Deitmer

⁸Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn

,

H. Olze

²Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Charité, Berlin

,

A. Glien

⁹Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Halle

,

S. Plontke

⁹Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Halle

,

H. Wrede

¹⁰Hals-, Nasen- und Ohrenarzt, Herford

,

W. Schlenter

¹¹Ärzteverband Deutscher Allergologen, Dreieich

,

H. J. Welkoborsky

¹²Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover

,

B. Wollenberg

⁴Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München

,

A. G. Beule

¹³Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster

,

C. Rudack

¹³Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster

,

M. Wagenmann

¹⁴Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Düsseldorf

,

T. Stöver

¹⁵Klinik für Hals, Nasen- und Ohrenheilkunde Universitätsklinikum Frankfurt am Main

,

T. Huppertz

¹⁶Klinik fur Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz

,

J. Hagemann

¹⁶Klinik fur Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz

,

C. Bachert

¹⁷Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien

› Institutsangaben

Abstract

Zusammenfassung

Hintergrund Die chronische Rhinosinusitis (CRS) betrifft weltweit ca. 5–12 % der Allgemeinbevölkerung und wird traditionell eingeteilt in einen Phänotyp ohne (CRSsNP) und einen mit Ausbildung von Nasenpolypen (CRSwNP). Wurden Nasenpolypen bis vor kurzem eher als mechanisches Hindernis mit der Notwendigkeit einer operativen Beseitigung betrachtet, wird die CRSwNP heute als eine multifaktorielle entzündliche Erkrankung der nasalen und paranasalen Schleimhäute angesehen, der als Endotyp häufig eine T2-Inflammation zugrunde liegt. Biologika, die mit diesen Entzündungsmechanismen interferieren, stellen interessante neue Therapiemöglichkeiten dar.

Methoden Das aktuelle Wissen zur Immunologie der CRSwNP und Wirkung von Biologika wurde mittels einer Literaturanalyse durch Recherchen in Medline, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library zusammengestellt.

Ergebnisse Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Anwendung von Biologika bei CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben.

Schlussfolgerung Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren Verlaufsformen.

Schlüsselwörter

chronische Rhinosinusitis - Endotyp-Klassifizierung - nasale Polypen - CRSwNP - Biologika - Benralizumab - Dupilumab - Mepolizumab - Omalizumab - Reslizumab

Volltext

Referenzen

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