Biologic use and treatment patterns in patients with chronic rhinosinusitis with nasal polyps: a US real-world study

Abstract

Background: Several biologics are now approved in the US as add-on treatments for chronic rhinosinusitus with nasal polyps (CRSwNP). This cross-sectional, retrospective, real-world study aimed to characterize treatment patterns and identify predictors of biologic use among patients with CRSwNP. Methods: Adults in the Merative MarketScan Commercial and Medicare Supplemental Databases with medical claims for CRSwNP were identified June 2018–June 2019 (identification period [IP]). Patient characteristics were collated in the IP and treatment pattern data during the IP plus the following year (July 2019–June 2020; observation period [OP]). Data were stratified by sinus surgery and biologic use. Results: Of the 5997 eligible patients identified (58% male, mean age 48.1 years), 10.7% (n = 642) used biologics during the OP. More biologic users had common respiratory conditions than non-users, particularly asthma (89.1% vs 35.0%; P < 0.001). Biologic users had fewer diagnostic services but more drug-related services than non-users. Only 11.6% of patients who had sinus surgery used biologics, with most (56.1%) having their first biologic dose before sinus surgery and 12.5% ≤ 30 days after. Oral corticosteroid (OCS) use was higher in biologic users than non-users (all patients: 68.8% vs 42.5%; P < 0.001) and in those with/without sinus surgery. Comorbidities, prior OCS/doxycycline use, and age (< 65 years) increased the odds of biologic use, with asthma increasing the odds 5.46 times (P < 0.001). Conclusions: Biologic use was more common before first/next sinus surgery and in patients with high unmet need, elucidating predictors of biologic use that could be used in clinical practice.