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Therapeutic Antibodies for Nasal Polyposis Treatment: Where Are We Headed?

Authors
  • Agarwal, Aarti1
  • Spath, Derek1
  • Sherris, David A1
  • Kita, Hirohito2
  • Ponikau, Jens U3
  • 1 Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, Gromo Institute and Sinus Center, University at Buffalo, The State University of New York, 1237 Delaware Avenue, Buffalo, NY, 14209, USA.
  • 2 Department of Medicine, Division of Allergic Disease, Mayo College of Medicine, Mayo Clinic, Rochester, MN, USA.
  • 3 Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, Gromo Institute and Sinus Center, University at Buffalo, The State University of New York, 1237 Delaware Avenue, Buffalo, NY, 14209, USA. [email protected]
Type
Published Article
Journal
Clinical Reviews in Allergy & Immunology
Publisher
Springer-Verlag
Publication Date
Oct 01, 2020
Volume
59
Issue
2
Pages
141–149
Identifiers
DOI: 10.1007/s12016-019-08734-z
PMID: 31073812
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This review article aims to outline what is known in the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) and describe the mechanism of the biologic agents being investigated for this disease. Chronic rhinosinusitis with nasal polyposis is an inflammatory disease of the nasal and paranasal mucosa, which causes symptoms of nasal obstruction, hyposmia, and rhinorrhea. Conventional therapy for CRSwNP includes intranasal corticosteroids (INCS) and polypectomy, but INCS offer only modest benefits, and recurrence after surgery is common. Therefore, effective pharmacologic therapies for CRSwNP are being actively sought. Monoclonal antibodies have been successful in other chronic diseases involving eosinophilic inflammation, such as chronic urticaria and asthma. Thus, researchers have begun expanding their scope and investigating the efficacy of these drugs in the treatment of nasal polyposis. The monoclonal antibodies under investigation (omalizumab (anti IgE), dupilumab (anti IL-4/IL-13), and reslizumab and mepolizumab (both anti IL-5), benralizumab (anti IL-5Rα), and etokimab (anti IL-33)) target key players in the pathophysiology of nasal polyposis (NP). Dupilumab has just completed phase III trials for CRSwNP with positive results, while omalizumab, mepolizumab, and benralizumab are currently in phase III trials for this indication. At this time, while there are no FDA-approved biologics for use in NP, research has highlighted the contributions of IL-4, IL-5, IL-13, and IgE as disease mediators in the pathogenesis of NP. The current FDA-approved treatment of intranasal steroids does not provide significant relief for many patients; therefore, these phase III trials of monoclonal antibodies bring hope for an exciting new treatment option.

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