Outcomes of Maximal Conventional Therapy Before Biological Treatment in Recurrent Chronic Rhinosinusitis With Nasal Polyps.

OBJECTIVE

To determine whether biological therapy is a viable option for individuals with recurrent chronic rhinosinusitis with nasal polyps (CRSwNP), we will assess the clinical outcomes of maximal conventional therapy (MCT).

METHODS

For this retrospective analysis, 42 adults with recurrent CRSwNP after prior endoscopic sinus surgery (ESS) were included. Intranasal corticosteroid sprays, a brief oral steroid taper, leukotriene antagonists, culture-directed antibiotics as needed, and optimal care of co-occurring asthma and allergies were components of a standardized MCT protocol that all patients underwent. Baseline and 12-week outcomes were assessed using SNOT-22, NPS, and PNIF (peak nasal inspiratory flow).

RESULT: Nearly 70% of patients (29 of 42) showed a statistically significant improvement in their SNOT-22 scores (a decrease of at least 8.9%) after 12 weeks. On average, PNIF increased by 24%, and 57% saw an improvement of at least 1 point in NPS. Thirteen percent (13 out of 42) of patients who attempted MCT failed because of ongoing blockage, polyp recurrence, or co-occurring asthma symptoms; these patients were therefore considered candidates for biologics. No serious side effects were reported.

CONCLUSION

In nearly two-thirds of cases, MCT may reduce the need for biologics and provide clinically significant improvement in the majority of patients with recurrent CRSwNP. Identifying the fraction of patients who require biological treatment can be aided by a structured prebiologic evaluation such as this.