The term chronic rhinosinusitis (CRS) is an umbrella term that covers different conditions related with the paranasal sinus system. In recent years, effort was made to understand the underlying pathophysiology in terms of detecting its phenotypes and endotypes. These efforts resulted with the identification of biomarkers that have an important role in pathophysiology of CRS. CRS is mainly divided into two phenotypes: CRS without (sine) nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). CRS with nasal polyposis share the same mechanisms with allergic rhinitis and asthma in which type 2 inflammation is predominant. Biological monoclonal antibodies have a long use for treatment of uncontrolled asthma. Based on previous experience with asthma and allergic diseases, biological treatments started to gain place in management of uncontrolled CRS which is difficult to treat against maximal treatment effort. Recently; European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) was released at the beginning of 2020. For the first time, EPOS 2020 reported the indications of biological products in treatment of CRS. It is predictable that targeted biological treatments are going to take place in standard treatment of CRS in ongoing years. Biological monoclonal antibodies offer 'precision treatment' for various diseases for decades. They offer a new targeted therapy, however their use in new areas are still under investigation. This review is focused on available literature related with the use of biologics in treatment of CRS.
Keywords: Omalizumab; mepolizumab; dupilumab; reslizumab; phenotype; monoclonal antibody
Kronik rinosinüzit (KRS) terimi, paranazal sinüs sistemi ile ilgili farklı hastalıkları kapsayan bir şemsiye terimidir. Son yıllarda KRS fizyopatolojisi, KRS fenotip ve endotiplerini saptamak üzerine yapılan çalışmalar artmıştır. Çalışmalar KRS fizyopatolojisi önemli rol oynayan biyobelirteçlerin tanımlanması ile sonuçlanmıştır. KRS temel olarak iki fenotipe ayrılır. Bunlar burun poliplerinin eşlik etmediği KRS ve burun poliplerinin eşlik ettiği KRS'lerdir. Nazal poliplerin eşlik ettiği KRS, tip 2 inflamasyonun baskın olduğu alerjik rinit ve astım ile aynı mekanizmaları paylaşır. Biyolojik monoklonal antikorlar, kontrolsüz astım tedavisi için uzun süredir kullanım alanına sahiptir. Astım ve alerjik hastalıklarla ilgili önceki deneyimlere dayanarak, maksimum tedavi çabalarına karşı tedavisi zor olan kontrolsüz KRS'lerde biyolojik tedaviler yer almaya başlamıştır. En güncel olarak; European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) 2020'nin başında yayınlandı. EPOS 2020 ilk kez KRS tedavisinde biyolojik ürünlerin endikasyonlarını bildirdi. Hedefli biyolojik tedavilerin, KRS'in standart tedavisinde devam eden yıllarda olacağı öngörülebilir. Biyolojik monoklonal antikorlar, onlarca yıldır çeşitli hastalıklar için "hassas tedavi" olanağı sunmaktadır. Yeni bir hedefe yönelik tedavi seçeneği sunan bu ajanların, yeni alanlarda kullanımları halen araştırılmaktadır. Bu derleme, KRS tedavisinde biyolojik ürünlerin kullanımı ile ilgili mevcut literatürü derlemeyi amaçlamıştır.
Anahtar Kelimeler: Omalizumab; mepolizumab; dupilumab; reslizumab; fenotip; monoklonal antikor
- Iqbal IZ, Kao SS, Ooi EH. The role of biologics in chronic rhinosinusitis: a systematic review. Int Forum Allergy Rhinol. 2020;10(2):165-74. [Crossref] [PubMed]
- Licari A, Castagnoli R, De Filippo M, Foiadelli T, Tosca MA, Marseglia GL, et al. Current and emerging biologic therapies for allergic rhinitis and chronic rhinosinusitis. Expert Opin Biol Ther. 2020;19:1-11.
- Chong LY, Piromchai P, Sharp S, Snidvongs K, Philpott C, Hopkins C, et al. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev. 2020;2(2):CD013513. [Crossref]
- Nasta MS, Chatzinakis VA, Georgalas CC. Updates on current evidence for biologics in chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2020;28(1):18-24. [Crossref] [PubMed]
- Cardell LO, Stjärne P, Jonstam K, Bachert C. Endotypes of chronic rhinosinusitis: impact on management. J Allergy Clin Immunol. 2020;145(3):752-6. [Crossref] [PubMed]
- Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
- Workman AD, Kohanski MA, Cohen NA. Biomarkers in chronic rhinosinusitis with nasal polyps. Immunol Allergy Clin North Am. 2018;38(4):679-92. [Crossref] [PubMed] [PMC]
- Bachert C, Gevaert P, Hellings P. Biotherapeutics in chronic rhinosinusitis with and without nasal polyps. J Allergy Clin Immunol Pract. 2017;5(6):1512-6. [Crossref] [PubMed]
- Shepard HM, Phillips GL, D Thanos C, Feldmann M. Developments in therapy with monoclonal antibodies and related proteins. Clin Med (Lond). 2017;17(3):220-32. [Crossref] [PubMed] [PMC]
- Monoclonal antibodies. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. 2012-2019.
- Selimoğlu SM, Kasap M, Akpınar G, Karadenizli A. [Yesterday, today and the future of monoclonal antibody technology]. Journal of Health Sciences of Kocaeli University. 2016;2(1):6-14. [Crossref]
- Understanding monoclonal antibodies. Drug Ther Bull. 2007;45(7):55-6. [Crossref] [PubMed]
- An Z. Monoclonal antibodies-a proven and rapidly expanding therapeutic modality for human diseases. Protein Cell. 2010;1(4):319-30. [Crossref] [PubMed] [PMC]
- Kartush AG, Schumacher JK, Shah R, Patadia MO. Biologic agents for the treatment of chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2019;33(2):203-11. [Crossref] [PubMed]
- Rivero A, Liang J. Anti-IgE and anti-IL5 biologic therapy in the treatment of nasal polyposis: a systematic review and meta-analysis. Ann Otol Rhinol Laryngol. 2017;126(11):739-47. [Crossref] [PubMed]
- Pinto JM, Mehta N, DiTineo M, Wang J, Baroody FM, Naclerio RM. A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis. Rhinology. 2010;48(3):318-24. [Crossref] [PubMed]
- Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol. 2013;131(1):110-6.e1. [Crossref] [PubMed]
- Bachert C, Sousa AR, Lund VJ, Scadding GK, Gevaert P, Nasser S, et al. Reduced need for surgery in severe nasal polyposis with mepolizumab: randomized trial. J Allergy Clin Immunol. 2017;140(4):1024-31.e14. [Crossref] [PubMed]
- Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van Zele T, Acke F, et al. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol. 2011;128(5):989-95.e1-8. [Crossref] [PubMed]
- Smith KA, Pulsipher A, Gabrielsen DA, Alt JA. Biologics in chronic rhinosinusitis: an update and thoughts for future directions. Am J Rhinol Allergy. 2018;32(5):412-23. [Crossref] [PubMed] [PMC]
- Van Zele T, Holtappels G, Gevaert P, Bachert C. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014;28(3):192-8. [Crossref] [PubMed]
- Wagenmann M, Scheckenbach K, Chaker AM. Endotypes in chronic rhinosinusitis: biomarkers based on a mechanistic insight for targeted treatment? ORL J Otorhinolaryngol Relat Spec. 2017;79(1-2):78-84. [Crossref] [PubMed]
- Liao B, Liu JX, Li ZY, Zhen Z, Cao PP, Yao Y, et al. Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes. Allergy. 2018;73(7):1459-69. [Crossref] [PubMed] [PMC]
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