Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study
Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targe...
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SAGE Publishing
2023-04-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | https://doi.org/10.1186/s40463-023-00626-9 |
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| author | Andrew V. Thamboo Melissa Lee Mohit Bhutani Charles Chan Yvonne Chan Ken R. Chapman Christopher J. Chin Lori Connors Del Dorscheid Anne K. Ellis Richard M. Gall Krystelle Godbout Arif Janjua Amin Javer Shaun Kilty Harold Kim Gordon Kirkpatrick John M. Lee Richard Leigh Catherine Lemiere Eric Monteiro Helen Neighbour Paul K. Keith George Philteos Jaclyn Quirt Brian Rotenberg Juan C. Ruiz John R. Scott Doron D. Sommer Leigh Sowerby Marc Tewfik Susan Waserman Ian Witterick Erin D. Wright Cory Yamashita Martin Desrosiers |
| author_facet | Andrew V. Thamboo Melissa Lee Mohit Bhutani Charles Chan Yvonne Chan Ken R. Chapman Christopher J. Chin Lori Connors Del Dorscheid Anne K. Ellis Richard M. Gall Krystelle Godbout Arif Janjua Amin Javer Shaun Kilty Harold Kim Gordon Kirkpatrick John M. Lee Richard Leigh Catherine Lemiere Eric Monteiro Helen Neighbour Paul K. Keith George Philteos Jaclyn Quirt Brian Rotenberg Juan C. Ruiz John R. Scott Doron D. Sommer Leigh Sowerby Marc Tewfik Susan Waserman Ian Witterick Erin D. Wright Cory Yamashita Martin Desrosiers |
| author_sort | Andrew V. Thamboo |
| collection | DOAJ |
| description | Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ( $$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract |
| format | Article |
| id | doaj-art-55e88f515c324fecb00a7635d8bdad2d |
| institution | OA Journals |
| issn | 1916-0216 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | SAGE Publishing |
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| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-55e88f515c324fecb00a7635d8bdad2d2025-08-20T02:04:55ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162023-04-0152113610.1186/s40463-023-00626-9Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi studyAndrew V. Thamboo0Melissa Lee1Mohit Bhutani2Charles Chan3Yvonne Chan4Ken R. Chapman5Christopher J. Chin6Lori Connors7Del Dorscheid8Anne K. Ellis9Richard M. Gall10Krystelle Godbout11Arif Janjua12Amin Javer13Shaun Kilty14Harold Kim15Gordon Kirkpatrick16John M. Lee17Richard Leigh18Catherine Lemiere19Eric Monteiro20Helen Neighbour21Paul K. Keith22George Philteos23Jaclyn Quirt24Brian Rotenberg25Juan C. Ruiz26John R. Scott27Doron D. Sommer28Leigh Sowerby29Marc Tewfik30Susan Waserman31Ian Witterick32Erin D. Wright33Cory Yamashita34Martin Desrosiers35Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British ColumbiaDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British ColumbiaDepartment of Respirology, University of AlbertaDepartment of Medicine, University of TorontoDepartment of Otolaryngology-Head and Neck Surgery, University of TorontoDepartment of Medicine, University of TorontoDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie UniversityDepartment of Medicine, Dalhousie UniversityDepartment of Medicine, University of British ColumbiaDivision of Allergy and Immunology, Department of Medicine, Queen’s UniversityDepartment of Otolaryngology-Head and Neck Surgery, University of ManitobaDepartment of Medicine, Laval UniversityDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British ColumbiaDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British ColumbiaDepartment of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa HospitalDivision of Clinical Immunology and Allergy, Department of Medicine, Western UniversityDivision of Respiratory Medicine, University of British ColumbiaDepartment of Otolaryngology-Head and Neck Surgery, University of TorontoDepartment of Medicine, University of CalgaryDepartment of Medicine, CIUSS du Nord de l’île de Montreal, Université de MontrealDepartment of Medicine, University of TorontoDivision of Clinical Immunology and Allergy, Department of Medicine, McMaster UniversityDivision of Clinical Immunology and Allergy, Department of Medicine, McMaster UniversityLakeridge HealthDivision of Clinical Immunology and Allergy, Department of Medicine, McMaster UniversityDepartment of Otolaryngology-Head and Neck Surgery, Western UniversityDivision of Clinical Immunology and Allergy, University of CalgaryDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie UniversityDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster UniversityDepartment of Otolaryngology-Head and Neck Surgery, Western UniversityDepartment of Otolaryngology-Head and Neck Surgery, McGill UniversityDivision of Clinical Immunology and Allergy, Department of Medicine, McMaster UniversityDepartment of Otolaryngology-Head and Neck Surgery, University of TorontoDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of AlbertaDepartment of Medicine, Western UniversityDivision of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l’Université de MontrealAbstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ( $$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstracthttps://doi.org/10.1186/s40463-023-00626-9Chronic rhinosinusitisChronic rhinosinusitis with nasal polyposisUpper airway diseaseLower airway diseaseAsthmaBiologics |
| spellingShingle | Andrew V. Thamboo Melissa Lee Mohit Bhutani Charles Chan Yvonne Chan Ken R. Chapman Christopher J. Chin Lori Connors Del Dorscheid Anne K. Ellis Richard M. Gall Krystelle Godbout Arif Janjua Amin Javer Shaun Kilty Harold Kim Gordon Kirkpatrick John M. Lee Richard Leigh Catherine Lemiere Eric Monteiro Helen Neighbour Paul K. Keith George Philteos Jaclyn Quirt Brian Rotenberg Juan C. Ruiz John R. Scott Doron D. Sommer Leigh Sowerby Marc Tewfik Susan Waserman Ian Witterick Erin D. Wright Cory Yamashita Martin Desrosiers Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study Journal of Otolaryngology - Head and Neck Surgery Chronic rhinosinusitis Chronic rhinosinusitis with nasal polyposis Upper airway disease Lower airway disease Asthma Biologics |
| title | Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study |
| title_full | Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study |
| title_fullStr | Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study |
| title_full_unstemmed | Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study |
| title_short | Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study |
| title_sort | canadian multidisciplinary expert consensus on the use of biologics in upper airways a delphi study |
| topic | Chronic rhinosinusitis Chronic rhinosinusitis with nasal polyposis Upper airway disease Lower airway disease Asthma Biologics |
| url | https://doi.org/10.1186/s40463-023-00626-9 |
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