Utilization of Corticosteroid Delivery Systems for Treatment of Nasal Polyposis - Episode 16
Drs Anju Peters and Naveen Bhandarkar, comment on the challenges of using biologic therapies to treat patients with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP).
Anju Peters, MD: Let's move on to the next question. Dareen, this is for you. You do a lot of clinical trials. How do use clinical trials for patients, who for example, have stopped responding to their current treatment? Do you offer them other clinical trials?
Dareen Siri, MD, FAAAAI, FACAAI: My answer transitions to some of both of your points, in that, as I discussed, in some of these complicated patients with the excellent ENTs school of medicine in my area. We typically will try one of these biologics for probably about 6 months. I would like to see what you guys are thinking about that as well, and certainly if there's a feeler, we might try a different one. And, funny enough with these medications, unlike asthma, which clearly states this is an add on therapy with biologics, that's not very clear with all the biologics in terms of the use with nasal polyposis, which I find kind of interesting because that the similar inflammation is underlying it. I certainly think that the best success is add on treatment, meaning that we're addressing the underlying inflammation with something like EDS-FLU, as well as the use of biologics. But beyond that, one of the big barriers for us is that all these medications, IL-4, IL-13, anti-IgE, anti-eosinophils, IL-5, is that they are focused on that type 2 inflammation. And the deficit or the lack is that what about those patients who do not have an underlying type 2 inflammation, or a sinophilic inflammation status. And in those patients, perhaps, that where is where the clinical trials may be utilized for them, with some of the newer developing therapies. Or perhaps, they do have that inflammation, but they are still having some lack of symptoms that are being addressed, and really are feeling still some issues. And of course, we've assumed that we've worked these patients up for all the underlying diseases that we're worried about. But we have encountered these patients, you know, similar to some of the other disease states where we've treated them, the polyps have improved. We have much less inflammation, but the patients continue, for example, to have significant facial pain pressure. There are certainly opportunities for them going forward for some newer medications.
Transcript edited for clarity