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Licari A, Castagnoli R, De Filippo M, Foiadelli T, Tosca MA, Marseglia GL, Ciprandi G. Current and emerging biologic therapies for allergic rhinitis and chronic rhinosinusitis. Expert Opin Biol Ther 2020; 20:609-619. [PMID: 32053391 DOI: 10.1080/14712598.2020.1729350] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Allergic rhinitis and chronic rhinosinusitis, with and without nasal polyps, are the most common chronic inflammatory diseases of the upper airways. They both cause relevant respiratory symptoms and a substantial detriment to patients' quality of life, mainly in uncontrolled and severe patients.Areas covered: This review aims to present the most recent evidence on current and emerging biologic therapies for allergic rhinitis and chronic rhinosinusitis and discuss their potential implementation in clinical practice. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed database, using terms 'biologics OR biological agents', 'allergic rhinitis' and 'chronic rhinosinusitis'. The literature review was performed for publication years 2009-2019, restricting the articles to humans and English language publications.Expert opinion: Biological therapies represent a potential step forward in providing individualized care for all patients with uncontrolled severe upper airway diseases. Biologics recently showed promising results for the treatment of severe uncontrolled allergic rhinitis and chronic rhinosinusitis with nasal polyps with or without associated asthma. Endotyping inflammatory pathways and identifying related biomarkers remain the major challenge for positioning biologics in the care pathway of chronic respiratory diseases.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria De Filippo
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Thomas Foiadelli
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Passali D, Bellussi LM, Damiani V, Tosca MA, Motta G, Ciprandi G. Chronic rhinosinusitis with nasal polyposis: the role of personalized and integrated medicine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:11-18. [PMID: 32073556 PMCID: PMC7947745 DOI: 10.23750/abm.v91i1-s.9243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 02/06/2023]
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a frequent disorder. From a clinical and an immunopathological point of view, different phenotypes and endotypes have been identified. The frequent comorbidity with asthma allowed to pave the way to the use of biological agents for the treatment of CRSwNP. Biological agents are targeted to antagonize IgE, interleukin (IL) 4, IL-5, and IL-13 at present. However, a correct and appropriate workup is mandatory, mainly concerning the exact definition of the specific pheno-endotype. The preliminary outcomes are promising, even though there is a need for well-established indications, criteria of responsiveness, duration, and safety. On the other hand, this personalized medicine could be fruitfully integrated with gold-standard medications, such as intranasal corticosteroids. As CRSwNP is a chronic disorder, treatment should be long-lasting, so complementary anti-inflammatory treatments could be opportunely integrated and/or alternated to steroids. (www.actabiomedica.it)
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Affiliation(s)
| | | | | | | | - Gaetano Motta
- ENT Department, University Luigi Vanvitelli, Naples, Italy.
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3
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Fokkens WJ, Lund V, Bachert C, Mullol J, Bjermer L, Bousquet J, Canonica GW, Deneyer L, Desrosiers M, Diamant Z, Han J, Heffler E, Hopkins C, Jankowski R, Joos G, Knill A, Lee J, Lee SE, Mariën G, Pugin B, Senior B, Seys SF, Hellings PW. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy 2019; 74:2312-2319. [PMID: 31090937 PMCID: PMC6972984 DOI: 10.1111/all.13875] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 12/12/2022]
Abstract
Novel therapies such as type 2 targeting biologics are emerging treatment options for patients with chronic inflammatory respiratory diseases, fulfilling the needs of severely uncontrolled patients. The majority of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and over half of patients with asthma show a type 2 inflammatory signature in sinonasal mucosa and/or lungs. Importantly, both chronic respiratory diseases are frequent comorbidities, ensuring alleviation of both upper and lower airway pathology by systemic biological therapy. Type 2-targeting biologics such as anti-IgE, anti-IL4Rα, anti-IL5, and anti-IL5Rα have entered the market for selected pheno/endotypes of asthma patients and may soon also become available for CRSwNP patients. Given the high prevalence of chronic respiratory diseases and the high cost associated with biologics, patient selection is crucial in order to implement such therapies into chronic respiratory disease care pathways. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organized a multidisciplinary Expert Board Meeting to discuss the positioning of biologics into the care pathways for CRSwNP patients with and without comorbid asthma.
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Affiliation(s)
- Wytske J. Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, Location AMC AmsterdamAmsterdamThe Netherlands
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
| | - Valerie Lund
- Royal National Throat, Nose and Ear HospitalUniversity College London HospitalsLondonUK
| | - Claus Bachert
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Upper Airways Research LaboratoryUniversity of GhentGentBelgium
- Division of ENT Diseases, CLINTECKarolinska Institute, and Department of ENT DiseasesKarolinska University HospitalStockholmSweden
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital ClínicUniversitat de Barcelona, IDIBAPS, CIBERESBarcelona, CataloniaSpain
| | - Leif Bjermer
- Department of Respiratory Medicine and AllergologyLund UniversityLundSweden
| | - Jean Bousquet
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Respiratory DiseaseUniversity Hospital Arnaud de VilleneuveMontpellierFrance
| | - Giorgio W. Canonica
- Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCSRozzano (MI)Italy
- Department of Biomedical ScienceHumanitas UniversityPieve Emanuele (MI)Italy
| | - Lauren Deneyer
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
| | - Martin Desrosiers
- Division of Otolaryngology‐Head & Neck SurgeryUniversity of Montreal Hospital Centre (CHUM)MontrealQuebecCanada
| | - Zuzana Diamant
- Department of Respiratory Medicine and AllergologyLund UniversityLundSweden
- Department of Clinical Pharmacy & Pharmacology and Department of General PracticeUMCG, and QPS‐NLGroningenThe Netherlands
- Department of Respiratory Medicine, First Faculty of MedicineCharles University and Thomayer HospitalPragueCzech Republic
| | - Joseph Han
- Department of Otolaryngology, Head & Neck SurgeryEastern Virginia Medical SchoolNorfolkVirginia
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCSRozzano (MI)Italy
- Department of Biomedical ScienceHumanitas UniversityPieve Emanuele (MI)Italy
| | | | - Roger Jankowski
- ENT DepartmentUniversity Hospital of Nancy, Brabois-ILMNancyFrance
| | - Guy Joos
- Department of Respiratory MedicineGhent University HospitalGentBelgium
| | | | - Jivianne Lee
- Rhinology & Endoscopic Skull Base SurgeryUCLA Department of Head & Neck SurgeryLos AngelesCalifornia
| | - Stella E. Lee
- Division of Sinonasal Disorders and Allergy, Department of Otolaryngology—Head & Neck SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania, USA
| | - Gert Mariën
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
| | - Benoit Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Microbiology, Immunology and TransplantationAllergy and Clinical Immunology Research GroupLeuvenBelgium
| | - Brent Senior
- Division of Rhinology, Allergy, and Endoscopic Skull Base SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Sven F. Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Microbiology, Immunology and TransplantationAllergy and Clinical Immunology Research GroupLeuvenBelgium
| | - Peter W. Hellings
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, Location AMC AmsterdamAmsterdamThe Netherlands
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Microbiology, Immunology and TransplantationAllergy and Clinical Immunology Research GroupLeuvenBelgium
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity Hospitals LeuvenLeuvenBelgium
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Kristin J, Burggraf M, Mucha D, Malolepszy C, Anderssohn S, Schipper J, Klenzner T. Automatic Registration for Navigation at the Anterior and Lateral Skull Base. Ann Otol Rhinol Laryngol 2019; 128:894-902. [PMID: 31067988 DOI: 10.1177/0003489419849086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Navigation systems create a connection between imaging data and intraoperative situs, allowing the surgeon to consistently determine the location of instruments and patient anatomy during the surgical procedure. The best results regarding the target registration error (measurement uncertainty) are normally demonstrated using fiducials. This study aimed at investigating a new registration strategy for an electromagnetic navigation device. METHODS For evaluation of an electromagnetic navigation system and comparison of registration with screw markers and automatic registration, we are calculating the target registration error in the region of the paranasal sinuses/anterior and lateral skull base with the use of an electromagnetic navigation system and intraoperative digital volume tomography (cone-beam computed tomography). We carried out 10 registrations on a head model (total n = 150 measurements) and 10 registrations on 4 temporal bone specimens (total n = 160 measurements). RESULTS All in all, the automatic registration was easy to perform. For the models that were used, a significant difference between an automatic registration and the registration on fiducials was evident for just a limited number of screws. Furthermore, the observed differences varied in terms of the preferential registration procedure. CONCLUSION The automatic registration strategy seems to be an alternative to the established methods in artificial and cadaver models of intraoperative scenarios. Using intraoperative imaging, there is an option to resort to this kind of registration as needed.
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Affiliation(s)
- Julia Kristin
- 1 Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Manuel Burggraf
- 2 Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | | | - Joerg Schipper
- 1 Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Thomas Klenzner
- 1 Department of Otorhinolaryngology, University Hospital Duesseldorf, Duesseldorf, Germany
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Hellings PW, Pugin B, Mariën G, Bachert C, Breynaert C, Bullens DM, Ceuppens JL, Clement G, Cox T, Ebo D, Gevaert P, Halewyck S, Hox V, Ladha K, Jacobs R, Rombaux P, Schrijvers R, Speleman K, Van der Brempt X, Van Gerven L, Vanderveken O, Verhaeghe B, Vierstraete K, Vlaminck S, Watelet JB, Bousquet J, Seys SF. Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement. Clin Transl Allergy 2019; 9:1. [PMID: 30740211 PMCID: PMC6360767 DOI: 10.1186/s13601-019-0243-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022] Open
Abstract
Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.
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Affiliation(s)
- P W Hellings
- 1ENT Clinical Department, University Hospital Leuven, Kapucijnenvoer 33, 3000 Louvain, Belgium.,2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - B Pugin
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - G Mariën
- European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - C Bachert
- 4ENT Clinical Department, University Hospital Ghent, Ghent, Belgium.,5Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium
| | - C Breynaert
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,6Internal Medicine Clinical Department, UZ Leuven, Louvain, Belgium
| | - D M Bullens
- 7Pediatrics Clinical Department, UZ Leuven, Louvain, Belgium
| | - J L Ceuppens
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,6Internal Medicine Clinical Department, UZ Leuven, Louvain, Belgium
| | - G Clement
- 8ENT Clinical Department, AZ Damiaan, Ostend, Belgium
| | - T Cox
- 9ENT Clinical Department, Jessa Hospital, Hasselt, Belgium
| | - D Ebo
- 10Immunology-Allergology-Rheumatology, University Hospital Antwerp, Antwerp, Belgium
| | - P Gevaert
- 4ENT Clinical Department, University Hospital Ghent, Ghent, Belgium.,5Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium
| | - S Halewyck
- 11ENT Clinical Department, UZ Brussel, Brussels, Belgium.,ENT Clinical Department, ASZ Aalst, Aalst, Belgium
| | - V Hox
- 13ENT Clinical Department, Clinique Universitaires Saint-Luc, Brussels, Belgium
| | - K Ladha
- 14Pediatrics Clinical Department, CHU Charleroi, Charleroi, Belgium
| | - R Jacobs
- 15ENT Clinical Department, AZ Sint-Blasius, Dendermonde, Belgium
| | - P Rombaux
- 13ENT Clinical Department, Clinique Universitaires Saint-Luc, Brussels, Belgium
| | - R Schrijvers
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,6Internal Medicine Clinical Department, UZ Leuven, Louvain, Belgium
| | - K Speleman
- 16ENT Clinical Department, AZ Sint-Jan, Brugge, Belgium
| | | | - L Van Gerven
- 1ENT Clinical Department, University Hospital Leuven, Kapucijnenvoer 33, 3000 Louvain, Belgium
| | - O Vanderveken
- 18ENT Clinical Department, University Hospital Antwerp, Antwerp, Belgium
| | - B Verhaeghe
- ENT Clinical Department, St-Andries ziekenhuis, Tielt, Belgium
| | - K Vierstraete
- 20ENT Clinical Department, AZ Groeninge, Kortrijk, Belgium
| | - S Vlaminck
- 21ENT Clinical Department, AZ Delta Roeselare, Roeselare, Belgium
| | - J-B Watelet
- 4ENT Clinical Department, University Hospital Ghent, Ghent, Belgium
| | - J Bousquet
- 22Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - S F Seys
- 1ENT Clinical Department, University Hospital Leuven, Kapucijnenvoer 33, 3000 Louvain, Belgium.,2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
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6
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Fokkens WJ, Pugin B, Bachert C, Bousquet J, Joos G, Louis R, Pilette C, Pfaar O, Price D, Prokopakis E, Scadding G, Strzembosz A, Weilandt A, Seys S, Hellings PW. Rhinology Future Debates 2017 by EUFOREA: Novel treatments and surgical solutions in rhinology. Clin Otolaryngol 2018; 43:1429-1438. [DOI: 10.1111/coa.13184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Wytske J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| | - Benoit Pugin
- European Forum for Research and Education in allergy and Airway Diseases (EUFOREA); Brussels Belgium
| | - Claus Bachert
- Ghent University Hospital; Ghent Belgium
- Karolinska Institute; Stockholm Sweden
| | - Jean Bousquet
- European Forum for Research and Education in allergy and Airway Diseases (EUFOREA); Brussels Belgium
- INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif; Université Versailles St-Quentin-en-Yvelines, UMR-S 1168; Montigny le Bretonneux France
- MACVIA-France and fondation FMC-VIA-LR; Montpellier France
| | - Guy Joos
- Department of Respiratory Medicine; Ghent University Hospital; Gent Belgium
| | - Renaud Louis
- Department of Pneumology; CHU Liege, GIGA I; University of Liege; Liege Belgium
| | - Charles Pilette
- Department of Pulmonology; Cliniques Universitaires St-Luc and Research Pole of Pneumology, ENT and Dermatology; Université Catholique de Louvain; Brussels Belgium
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Medical Faculty Mannheim; Universitätsmedizin Mannheim, Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - David Price
- Centre of Academic Primary Care; University of Aberdeen; Aberdeen UK
- Observational and Pragmatic Research Institute; Singapore Singapore
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklion Greece
| | | | | | | | - Sven Seys
- European Forum for Research and Education in allergy and Airway Diseases (EUFOREA); Brussels Belgium
| | - Peter W. Hellings
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
- Ghent University Hospital; Ghent Belgium
- Clinical Division of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
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Abstract
Purpose of Review Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition. Recent Findings This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment. Summary This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
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