FESS, Biologics, and Biomarkers: A Strategic Approach to Managing CRSwNP

PROGRAM DESCRIPTION: Chronic sinusitis with nasal polyposis is becoming more widely recognized as a Type 2 inflammatory disease but the best treatment strategies for personalized patient treatment and which biomarkers to use to predict treatment success are still being investigated. For some patients, a complete FESS followed by medical therapy is successful at controlling disease recurrence. For others, this is not the case, sometimes requiring numerous additional surgeries to control the burden of disease. With the advent of FDA approved biologics for nasal polyps and additional Phase three trials combining biologic use with surgery, there is the potential to use available biomarkers and patient characteristics to direct therapy to minimize the need for further additional surgery and corticosteroid use. This panel uses patient cases with biomakers, images, and videos, as well as currently available evidence and guidelines, to discuss different therapeutic approaches to treatment and ways to potentially answer the questions: Who will do well with just surgery and medicated rinses? Who will need adjuvant biologic therapy or would need that treatment first?

OUTCOME OBJECTIVE 1: 1. List the available biomarkers and their practical clinical application in decision-making for treatment of CRSsNP.

OUTCOME OBJECTIVE 2: 2. Describe the utilization of biologic therapies for CRSwNP alone, pre-, and post-FESS.

OUTCOME OBJECTIVE 3: 3. Discuss a guided, personalized treatment approach to CRSwNP using FESS, medical therapy, and biologics.

BACKGROUND STATEMENT: Biologics are novel therapeutic medications for the targeted therapy for a variety of inflammatory conditions. Three biologics are FDA approved for CRSwNP, 3 or more others are in Phase III trials. As these medications become cheaper and used more commonly, this may alter how we treat CRSwNP