Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review

Ahmad A Mirza; Hebatullah M Abdulazeem; Ahmed A Al-Sayed; Talal A Alandejani; Hatim Y Shawli; Jacqueline Y Thompson; Mohammed H Alhaddad; Rickul Varshney; Faisal Zawawi

doi:10.1007/s12070-022-03144-8

Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review

Indian J Otolaryngol Head Neck Surg. 2023 Apr;75(Suppl 1):650-660. doi: 10.1007/s12070-022-03144-8. Epub 2022 Oct 15.

Authors

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
² Department of Sport and Health Sciences, Technische Universität München, München, Germany.
³ Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁴ Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada.
⁵ Department of Surgery-Division of Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
⁶ Department of Surgery-Division of Otolaryngology, Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
⁷ King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
⁸ Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
⁹ Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
¹⁰ Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada.
¹¹ Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

Abstract

Objectives: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP.

Data source: Systematic Review of three electronic databases.

Review methods: Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs.

Results: A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported.

Conclusion: The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-022-03144-8.

Keywords: Biologic therapy; Meta-analysis; Monoclonal antibodies; Nasal polyps; Review; Sinusitis; Systematic review.

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