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Laryngorhinootologie 2021; 100(02): 134-145
DOI: 10.1055/a-1309-6631
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Biologika: Neue Therapieoption bei schwerer chronisch polypöser Rhinosinusitis

Biologics: A New Option in Treatment of Severe Chronic Rhinosinusits with Nasal Polyps
Mandy Cuevas
,
Thomas Zahnert
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Die chronische Rhinosinusitis (CRS) zählt mit einer Prävalenz von bis zu 12 % zu einer der häufigsten chronischen Erkrankungen. Die Betroffenen berichten über eine starke Einschränkung ihrer Lebensqualität und meist einen langen Leidensweg. Trotz der bisherigen Standardtherapie ist die Erkrankung oft nicht ausreichend kontrolliert. Der folgende Artikel beschreibt Indikationen und Durchführung einer neuen Therapieoption mit Biologika.

Abstract

Chronic rhinosinusitis (CRS) is defined as an inflammation of the nose and paranasal sinuses with prevalence of 10.9 % and by the presents of 2 or more symptoms, which last more than 12 weeks. The symptoms are nasal obstruction, nasal discharge (anterior/post nasal drip), facial pain or pressure and/or olfactory disorder. CRS has a high negative impact on an individual’s quality of life. The pathogenesis is multifactorial and complex. CRS has been subclassified into 2 groups: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Regarding further knowledge of the inflammatory pathway the primary CRS is considered by endotype dominance, either type 2 or non-type 2. 80 % of the CRSwNP reveals a type 2 inflammation. The proteins, interleukin (IL)-4, IL-5, IL-13, and IgE were previously identified as key mediators in nasal polyp tissues pattern. CRSwNP is often refractory to medical and surgical management, especially in patients with asthma and aspirin intolerance. In most cases the control of the disease is a challenge. Patients with asthma but especially with Samter’s triad are significantly more likely to have a recurrence of nasal polyps and undergo a second surgery following recurrence. In patients with severe CRSwNP, in whom the current standard of care including topical and oral corticosteroids, antibiotics and surgical procedures fail to control the disease, biologics can open new perspectives in treatment. They allow avoiding the possible adverse events resulting from repeated use of systemic corticosteroids and surgery. These biologics have a high impact on type 2 immune reaction and lead to a reduction of IgE as well as of local mucosal eosinophil migration and activation, resulting in a significant effect on nasal polyps, smell, quality of life and asthma comorbidity.

Schlüsselwörter

chronische Rhinosinusitis mit Polypen - Inflammation - Endotyp - Biologika

Key words

Chronic Rhinosinusits with Nasal Polyps (CRSwNP) - inflammation - endotype - biologics


Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2021

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