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Review
. 2018 Sep;32(5):412-423.
doi: 10.1177/1945892418787132. Epub 2018 Jul 19.

Biologics in Chronic Rhinosinusitis: An Update and Thoughts for Future Directions

Kristine A Smith  1 , Abigail Pulsipher  1   2 , David A Gabrielsen  1 , Jeremiah A Alt  1
Affiliations
Review

Biologics in Chronic Rhinosinusitis: An Update and Thoughts for Future Directions

Kristine A Smith et al. Am J Rhinol Allergy. 2018 Sep.

Abstract

Background Potential biologic therapies for chronic rhinosinusitis (CRS) is a growing field of interest and research. Biologics target specific immune cells or inflammatory pathways within a disease process, increasing drug efficacy while reducing complications. The success of biologics in other inflammatory conditions such as asthma and atopic dermatitis has spurred much of the corresponding research in CRS. A rapid expansion in the volume of research concerning biologic therapies with potential crossover to treating CRS has made it difficult to stay current. Furthermore, much of the literature has been focused on allergy, asthma, and immunology subspecialties. As the role for biologic therapies in CRS continues to expand, it is increasingly important for otolaryngologists to remain up to date on their progression. Objective The objectives of this review are to provide an update on the growing field of biologics for otolaryngologists who treat CRS and discuss potential future areas of research. Methods A literature review of biologic therapies studied in CRS was performed. In addition, a detailed review of all biologic therapies targeting inflammatory markers involved in Th1-, Th2-, and Th17-mediated inflammation was performed to identify potential areas for future research. The role for biologic therapies in CRS, endotypes of CRS, current biologic therapies studies in CRS, and future areas for research were reviewed. Results Sixty-nine unique biologic therapies have been developed for Th1-, Th2-, and Th17-mediated inflammation. Five biologics are currently being investigated for use in patients with CRS with nasal polyposis. Conclusions As the field of biologics continues to expand, remaining up to date on the current literature may help clinicians identify patients who may benefit from biologic therapies. In addition, ongoing research in other inflammatory disorders with shared pathophysiology to CRS may reveal other potential therapies for CRS that have not previously been investigated.

Keywords: Th1; Th17; Th2; biologic therapy; biologics; chronic rhinosinusitis; eosinophilia; inflammation; polyps; systemic therapy.

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Figures

Figure 1.
Figure 1.
Schematic illustrating the pathophysiology of CRS with respect to subtype (CRSsNP and CRSwNP) and endotype (Th1, Th2, and Th17) with corresponding innate and adaptive immune modulator targets for biologic therapies. The bolded letters indicate biologic therapies that have been approved for other inflammatory conditions with overlapping pathophysiology or are in clinical development for CRS, as referenced in Tables 1 and 2. CCL, C-C motif chemokine ligand; CRSsNP, chronic rhinosinusitis without nasal polyposis; CRSwNP, chronic rhinosinusitis with nasal polyposis; B, B cell; DAMP, danger-associated molecular pattern; DC, dendritic cell; IFN, interferon; IgE, immunoglobulin E; IL, Interleukin; MC, mast cell; MHC-I, major histocompatibility complex class I; MHC-II, major histocompatibility complex class II; OX40L, OX40 ligand; PAMP, pathogen-associated molecular pattern; Th0, T helper cell type 0; Th1, T helper cell type 1; Th2, T helper cell type 2; Th17, T helper cell type 17; TSLP, thymic stromal lymphopoitein.
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