Introduction
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent
condition characterised by a significant impact on quality of life and
productivity, with frequent recurrence after both medical and surgical
treatment(1). Oral corticosteroids are effective at achieving short term
symptom improvement(2, 3), but benefit is limited due to the risk of
side effects which accrue with repeated use (4). Surgery has been shown
to achieve more durable symptomatic benefits (5), but is associated with
pain and discomfort, time for recovery, a small but definite risk of
serious complications(6), and, based on previous data, more than one in
5 patients will require another surgery within 5 years of follow-up(5).
Poor disease control is commonplace, driving the search for alternative
treatment strategies.
Monoclonal antibodies (Mabs) are biological treatments that target
specific inflammatory mediators or immune cells. Growing understanding
of the pathophysiological pathways found in CRSwNP and evidence of
efficacy in similar patterns of Type 2 inflammation found in asthma and
atopic dermatitis have led to trials evaluating use in CRSwNP. As such
therapies are evaluated and are shown to be effective, it will be
essential to consider where they should be placed in current treatment
pathways for CRSwNP, particularly with respect to the use of
corticosteroids and surgeries.
We set out to create Consensus Guidelines, based on current evidence and
relative risks of adverse effects and the costs of different treatments,
that reflect the views of the British Rhinological Society (BRS) Council
on where the use of biologics should be positioned within treatment
pathways for CRSwNP, specifically in the setting of the National Health
Service (NHS). These guidelines were created in early 2021 and it is
anticipated that they will evolve as further evidence accrues and the
relative costs and availability of treatments change.