title: Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis.
abstract: Chronic rhinosinusitis (CRS) affects more than 10% of the population in the United States and Europe. Recent findings point to a considerable variation of inflammatory subtypes in patients with CRS with nasal polyps and patients with CRS without nasal polyps. According to current guidelines, glucocorticosteroids and antibiotics are the principle pharmacotherapeutic approaches; however, they fail in a group of patients who share common clinical and laboratory markers. Several clinical phenotypes often leading to uncontrolled disease, including adult nasal polyposis, aspirin-exacerbated respiratory disease, and allergic fungal rhinosinusitis, are characterized by a common endotype: a TH2 bias is associated with a higher likelihood of comorbid asthma and recurrence after surgical treatment. As a consequence, several innovative approaches targeting the TH2 bias with humanized mAbs have been subjected to proof-of-concept studies in patients with CRS with nasal polyps with or without comorbid asthma: omalizumab, reslizumab, mepolizumab, and recently dupilumab. Future concepts using upstream targets, such as GATA-3, also focus on this endotype. This current development might result in advantages in the treatment of patients with the most severe CRS.
authors.affiliation: Upper Airways Research Laboratory and ENT Department, Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden. Electronic address: Claus.Bachert@ugent.be.
authors.forename: Claus
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Luo
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Upper Airways Research Laboratory and ENT Department, Ghent University Hospital, Ghent, Belgium.
authors.forename: Phillippe
authors.initials: P
authors.lastname: Gevaert
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000453:epidemiology; D015897:Comorbidity; D021881:DNA, Catalytic / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000453:epidemiology; D050990:GATA3 Transcription Factor / Q000276:immunology; D006801:Humans; D013294:Lactococcus lactis / Q000235:genetics; D009298:Nasal Polyps / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000601:surgery; D030781:Organisms, Genetically Modified; D012220:Rhinitis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000601:surgery; D012852:Sinusitis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000601:surgery
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D021881:DNA, Catalytic; D050990:GATA3 Transcription Factor; C494749:GATA3 protein, human; D001241:Aspirin
keywords: Chronic rhinosinusitis; GATA-3; IL-13; IL-4; IL-5; IgE; T(H)2; gene silencing; humanized and fully human mAbs; nasal polyps