Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis
Abstract Background Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and...
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SAGE Publishing
2021-03-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | https://doi.org/10.1186/s40463-021-00493-2 |
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| author | Andrew Thamboo S. Kilty I. Witterick Y. Chan C. J. Chin A. Janjua A. Javer J. Lee E. Monterio B. Rotenberg J. Scott K. Smith D. D. Sommer L. Sowerby M. Tewfik E. Wright M. Desrosiers |
| author_facet | Andrew Thamboo S. Kilty I. Witterick Y. Chan C. J. Chin A. Janjua A. Javer J. Lee E. Monterio B. Rotenberg J. Scott K. Smith D. D. Sommer L. Sowerby M. Tewfik E. Wright M. Desrosiers |
| author_sort | Andrew Thamboo |
| collection | DOAJ |
| description | Abstract Background Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight 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. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. 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. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the “3 point relaxed system”. Results After three rounds, a total of 11 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 CRS. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, 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-b4444ead10bd4c30b5af3769dbb7a9fe |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-b4444ead10bd4c30b5af3769dbb7a9fe2025-02-03T10:51:14ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162021-03-015011910.1186/s40463-021-00493-2Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitisAndrew Thamboo0S. Kilty1I. Witterick2Y. Chan3C. J. Chin4A. Janjua5A. Javer6J. Lee7E. Monterio8B. Rotenberg9J. Scott10K. Smith11D. D. Sommer12L. Sowerby13M. Tewfik14E. Wright15M. Desrosiers16Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British ColumbiaDepartment of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa HospitalDepartment of Otolaryngology-Head & Neck Surgery, University of TorontoDepartment of Otolaryngology-Head & Neck Surgery, University of TorontoDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie UniversityDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British ColumbiaDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British ColumbiaDepartment of Otolaryngology-Head & Neck Surgery, University of TorontoDepartment of Otolaryngology-Head & Neck Surgery, University of TorontoDepartment of Otolaryngology-Head and Neck Surgery, Western UniversityDivision of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie UniversityDepartment of Otolaryngology-Head and Neck Surgery, University of ManitobaDivision 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 Otolaryngology-Head and Neck Surgery, Department of Surgery, University of AlbertaDivision of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l’University de MontrealAbstract Background Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight 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. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. 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. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the “3 point relaxed system”. Results After three rounds, a total of 11 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 CRS. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, 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/s40463-021-00493-2Chronic RhinosinusitisBiologicsChronic rhinosinusitis with nasal polyposisType 2 inflammation |
| spellingShingle | Andrew Thamboo S. Kilty I. Witterick Y. Chan C. J. Chin A. Janjua A. Javer J. Lee E. Monterio B. Rotenberg J. Scott K. Smith D. D. Sommer L. Sowerby M. Tewfik E. Wright M. Desrosiers Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis Journal of Otolaryngology - Head and Neck Surgery Chronic Rhinosinusitis Biologics Chronic rhinosinusitis with nasal polyposis Type 2 inflammation |
| title | Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis |
| title_full | Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis |
| title_fullStr | Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis |
| title_full_unstemmed | Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis |
| title_short | Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis |
| title_sort | canadian rhinology working group consensus statement biologic therapies for chronic rhinosinusitis |
| topic | Chronic Rhinosinusitis Biologics Chronic rhinosinusitis with nasal polyposis Type 2 inflammation |
| url | https://doi.org/10.1186/s40463-021-00493-2 |
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