TY - JOUR
T1 - Evaluation of switching or simultaneous use of biologic treatment in patients with severe chronic rhinosinusitis with nasal polyps and severe asthma. Considerations in clinical decision making
AU - Otten, J.J.
AU - van der Lans, R.J.L.
AU - de Corso, E.
AU - Dziadziulia, kanstantsin
AU - Hilvering, Bart
AU - Weersink, E.J.M.
AU - Bonini, M.
AU - Hagemann, J.
AU - Thaitrakool, Wanrawee
AU - Montuori, Claudio
AU - Klimek, Ludger
AU - Reitsma, S.
AU - Fokkens, W.J.
N1 - Funding Information: This paper was not funded. Publisher Copyright: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023/5
Y1 - 2023/5
N2 - Introduction: Type 2 targeting biologics have reached the market first for asthma and since 2019 also for CRSwNP. As clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal treatment result. In this paper, we evaluate reasons for switching biologics and the treatment effects after each sequential switch. Materials and methods: Ninety-four patients who switched from one biologic to another for their treatment of CRSwNP and asthma were evaluated. Results: Twenty patients experienced satisfactory control of CRSwNP, but insufficient control of severe asthma. Fifty-one patients experienced satisfactory control of severe asthma, but insufficient control of CRSwNP/EOM. Twenty-eight patients experienced insufficient control of both upper and lower airways. Thirteen patients had to switch because of side effects. Furthermore, two cases are described to clarify clinical decision-making. Discussion: For abovementioned patients, a multidisciplinary approach is mandatory to find the best suitable biologic. It seems ineffective to switch to a second anti-IL5 treatment if the first one is not successful. Most patients that failed omalizumab and/or an anti-IL-5 treatment are well controlled on dupilumab. Therefore, we suggest to use dupilumab as first choice when switching biologic agents.
AB - Introduction: Type 2 targeting biologics have reached the market first for asthma and since 2019 also for CRSwNP. As clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal treatment result. In this paper, we evaluate reasons for switching biologics and the treatment effects after each sequential switch. Materials and methods: Ninety-four patients who switched from one biologic to another for their treatment of CRSwNP and asthma were evaluated. Results: Twenty patients experienced satisfactory control of CRSwNP, but insufficient control of severe asthma. Fifty-one patients experienced satisfactory control of severe asthma, but insufficient control of CRSwNP/EOM. Twenty-eight patients experienced insufficient control of both upper and lower airways. Thirteen patients had to switch because of side effects. Furthermore, two cases are described to clarify clinical decision-making. Discussion: For abovementioned patients, a multidisciplinary approach is mandatory to find the best suitable biologic. It seems ineffective to switch to a second anti-IL5 treatment if the first one is not successful. Most patients that failed omalizumab and/or an anti-IL-5 treatment are well controlled on dupilumab. Therefore, we suggest to use dupilumab as first choice when switching biologic agents.
KW - CRSwNP
KW - asthma
KW - biologics
KW - double treatment
KW - switching
UR - http://www.scopus.com/inward/record.url?scp=85161010875&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/1744666X.2023.2218617
DO - https://doi.org/10.1080/1744666X.2023.2218617
M3 - Article
C2 - 37226507
SN - 1744-666X
VL - 19
SP - 1041
EP - 1049
JO - Expert Review of Clinical Immunology
JF - Expert Review of Clinical Immunology
IS - 8
ER -