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Recent advances and knowledge of inflammatory endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) led to introduction of biological agents such as monoclonal antibodies targeting IgE (omalizumab) and Interleukins (ILs) such as IL4R alpha (dupilumab) and IL5. The European Academy of Allergy and Clinical Immunology (EAACI) performed a systematic review (SR) to evaluate the safety and efficacy of biological agents for patients with uncontrolled CRSwNP. The critical outcomes for the review were recurrence of NPs, need for surgery or for oral steroids, and safety in patients treated with biologicals. The patient group are those aged 12 years or older with nasal polyps on CT/endoscopy and uncontrolled symptoms on intranasal steroids. Searching the literature and scrutinising the results led to final inclusion of seven randomised controlled trials (RCTs) including 1236 patients with severe uncontrolled CRSwNP. Patients were followed up between 20 and 50 weeks. Authors also included two studies to investigate the cost-effectiveness. Authors reported that the most effective biological in reducing the need for surgery was dupilumab, with a reduction of 244 per 1000. Omalizumab was shown to reduce the need for surgery by 145 per 1000. Dupilumab was safer than placebo while omalizumab was associated with an increase in treatment-related adverse events by 28 per 1000. Cost-wise, the total cost of endoscopic surgery was $50,437, with a total of 9.80 QALYs, while for the dupilumab, the total cost was $536,420 with a total of 8.95 QALYs. Authors concluded that, after balancing the benefits and harms for dupilumab and omalizumab, panels are more likely to formulate conditional rather than strong recommendations.

Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines.
Agache I, Song Y, Alonso-Coello P, et al.
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Hassan Mohammed

North East Deanery, Newcastle, UK.

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