Comparison of Different Biologics for Treating Chronic Rhinosinusitis With Nasal Polyps: A Network Analysis

Shiru Cai; Shenglong Xu; Hongfei Lou; Luo Zhang

doi:10.1016/j.jaip.2022.02.034

Comparison of Different Biologics for Treating Chronic Rhinosinusitis With Nasal Polyps: A Network Analysis

J Allergy Clin Immunol Pract. 2022 Jul;10(7):1876-1886.e7. doi: 10.1016/j.jaip.2022.02.034. Epub 2022 Mar 8.

Authors

Shiru Cai¹, Shenglong Xu¹, Hongfei Lou², Luo Zhang³

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.
² Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China. Electronic address: louhongfei@yahoo.com.
³ Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China. Electronic address: dr.luozhang@139.com.

PMID: 35272073
DOI: 10.1016/j.jaip.2022.02.034

Abstract

Background: Several promising clinical trials have demonstrated the effects of type 2 biologics compared with placebos in chronic rhinosinusitis with nasal polyps (CRSwNP). However, there are no head-to-head randomized controlled trials (RCTs) between the biologics.

Objective: To compare the efficacy and safety of different biologics used for the treatment of CRSwNP.

Methods: We systematically identified RCTs investigating the effects of biologics for CRSwNP. Primary outcomes were nasal polyp score (NPS), nasal congestion severity, and serious adverse events. Secondary outcomes included the 22-item Sino-Nasal Outcome Test (SNOT-22) score, loss of smell severity, the University of Pennsylvania Smell Identification Test score, and the Lund-Mackay computed tomography score. Bucher indirect treatment comparison (ITC) was used to compare the outcome parameters.

Results: Seven RCTs (Bachert 2017, OSTRO, POLYP 1, POLYP 2, SINUS-24, SINUS-52, and SYNAPSE) involving 1913 patients and 4 biologics (benralizumab, dupilumab, mepolizumab, and omalizumab) were included for ITC. Dupilumab presented better effects in decreasing NPS and nasal congestion severity compared with the other 3 biologics at 24 weeks of the treatment and at the end of follow-up (more than 48 weeks). Benralizumab was the least effective in reducing nasal congestion severity and SNOT-22 score at 24 weeks. No significant differences were observed between the effects of the other biologics.

Conclusion: Our current findings suggest that dupilumab exhibits the best efficacy and safety for the treatment of CRSwNP.

Keywords: Benralizumab; Biologics; Chronic rhinosinusitis with nasal polyps; Dupilumab; Indirect treatment comparison; Mepolizumab; Omalizumab.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biological Products* / therapeutic use
Chronic Disease
Humans
Nasal Polyps* / therapy
Quality of Life
Rhinitis* / therapy
Sinusitis* / therapy

Substances

Biological Products