Dr. Ameen, ENT Specialist in Kuala Lumpur

Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) treated with omalizumab, dupilumab or mepolizumab: review of the current knowledge towards an attempt to compare agents’ efficacy – A systematic review

Abstract

Background

The heterogeneity of existing studies, along with the fact that there are no published head-to-head trials, are the main reasons for the lack of guidelines regarding the selection of the proper biologic in chronic rhinosinusitis with nasal polyps’ treatment. The aim of this study is to summarize the current knowledge regarding the efficacy of omalizumab, dupilumab and mepolizumab in Chronic Rhinosinusitis treatment. We also attempt to proceed to an indirect comparison of the agents and try to answer the tricky question: which agent to select and why?

Methods

An extensive search in English literature was conducted in Pubmed/Medline, Embase, Google Scholar and Cochrane Database/Library. Eligibility criteria included: papers with full text published in English, adult population studies, clearly described intervention protocol and documented primary and secondary outcomes.

Results

The studies included were 37. All agents provided significant improvement in polyp size, sinuses opacification, severity of symptoms, need for surgery and systemic corticosteroids use. Analysis of available systematic reviews, meta-analyses and Indirect Treatment Comparison studies showed that dupilumab appeared to be the most beneficial agent, in terms of primary and secondary outcomes. However, these results are of relatively low level of evidence due to several methodological limitations.

Conclusions

Although the present analysis showed a moderate supremacy of dupilumab, there is still no evidence-based answer to the question “which biologic agent is the most effective in CRS treatment?” Improved statistical methodology, head-to-head trials and real-life studies could lead to more robust conclusions, establishing the real role of the specific biologic agents.

Komen saya:

Ingat DUPILUMAB, currently the better drug/biologics for CRS (moderate supremacy). Keep checking this space for any updates for biologics in CRS ya 🙂