Retrospective analysis of Omalizumab therapy for severe, recurrent CRSwNP

Abstract

Chronic rhinosinusitis with nasal polyps can be difficult to treat and often shows a resistance to common therapy. Patients suffer from multiple revision surgerys and a loss of quality of life. A comorbidity of asthma is also prevalent in cohorts with nasal polyps. Both, CRSwNP and asthma, show a Typ2 inflammation with a high concentration of IgE. For those patients, one of the first Biologica, Omalizumab (anti-IgE-antibody), can be a promising option in therapy with a positive outcome. Currently, Omalizumab has no drug approval for treatment of CRSwNP. We did a retrospective evaluation of patients who suffer from CRSwNP and asthma between 2014-2017. Despite a maximum therapy their symptom control was insufficient and they receive a subcutaneous therapy of Omalizumab. We evaluated quality of life, size of polyps and lung function before and during the therapy with Omalizumab. In our patient cohort (n = 5) the results show that Omalizumab has a positive effect on quality of life. In summary, we detected an improved symptom control e.g. a reduction of rhinorrhoea, blocked nose, loss of smell and dypnoea. In conclusion, Omalizumab could be an alternative treatment option when it comes to therapy-resistant polyposis nasi with comorbid asthma wih an improved symptom control. Besides IgE, there are some more biomarkers like IL-5, IL-13, IL-4, IL-33 and TSLP (thymic stromal lymphopoetin) which play an important role in pathophysiology of CRSwNP. Newly developed antibodies against those target structures e.g. Mepolizumab, Dupilumab, Benralizumab are promising treatment approaches for those difficult to treat patients and should be moved forward in clinical studies.