Biologics for Nasal Polyps: What’s the Role? w/ Dr. Cecelia Damask & Dr. Matthew Ryan | Ep. 46
Вставка
- Опубліковано 20 вер 2022
- We talk with Dr. Cecelia Damask and Dr. Matt Ryan about the role of Biologics for Nasal Polyps, including patient selection and its place in the treatment plan.
---
EARN CME
Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: earnc.me/3w9pL5
---
SHOW NOTES
In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, Dr. Cecelia Damask (Lake Mary ENT and Allergy), and Dr. Matt Ryan (UT Southwestern Otolaryngology) discuss the growing role of biologics for nasal polyps.
Biologics are monoclonal antibodies that block T2-mediated immune responses (IL-3, IL-4, IL-13, IgE). They are administered subcutaneously and follow various dosing regimens. Biologics are a viable treatment option in patients with recurrent nasal polyps who have failed conventional therapies, such as high doses of antihistamines, topical steroids, and systemic steroids. It is still considered as a last line treatment because of the high cost associated with production of monoclonal antibodies.
However, not all patients with recurrent nasal polyps are good candidates for biologics. The patient must present with a specific endotype--the T2-mediated etiology. T2-mediated patients can be identified through their high responsiveness to steroid therapy, positive history for allergic asthma and atopic dermatitis, and high peripheral eosinophil and serum IgE levels on a CBC with differential. In a surgery-naive patient with a temporary steroid response, it is best to perform sinus surgery first in order to widen the nasal mucosal surface area for efficient delivery of topical therapies. However, if post-surgical intranasal steroid sprays and saline irrigations are ineffective, biologics should be considered. It is best to avoid surgery and skip straight to biologics in patients with comorbid conditions that prevent surgery, patients with severe asthma, and patients with high peripheral IgE counts (1000+).
Once the decision to start biologic therapy is made, many factors have to be considered, such as insurance pre-authorization, administration methods, and frequency of dosing. Each biologic manufacturer has a “hub” that assists physicians and patients in navigating biologic dosing, delivery, and insurance paperwork. They will often have co-pay assistance programs for patient benefit as well. Common side effects observed in biologic trials are arthralgia, injection site inflammation, oropharyngeal pain, and headaches. However, all the doctors agree that these side effects are more mild than those of long-term systemic steroid use, which include avascular necrosis, cataracts, sepsis, and thromboembolic events.
Picking which biologic to prescribe is a clinical decision because they have not been subjected to comparative trials yet. The three biologics currently on the market are: Dupilumab (anti-IL-4 receptor), Omalizumab (anti-IgE), and Mepolizumab (anti-IL-5 receptor). All work to prevent T2 immune signaling by targeting different receptors. Factoring in comorbid conditions, payer systems, and dosing regimens can help a physician choose the best biologic for a nasal polyps patient.
---
The BackTable ENT Podcast is a resource for otolaryngologists to learn tips, techniques, and practical advice on all things ear, nose, and throat. Tune in to the BackTable ENT Podcast every week for candid conversations about rhinology, laryngology, otology, and head and neck surgery.
Get notified when new episodes drop! Subscribe to the BackTable ENT Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular otolaryngology updates.
UA-cam ► / @_backtableent
Twitter ► / _backtableent
LinkedIn ► / backtable-ent
Instagram ► / _backtableent
Newsletter ► www.backtable.com/shows/ent/s... - Наука та технологія
I was just diagnosed with a severe case of AERD(Samter's Triad) I actually diagnosed myself while in the ICU in the hospital after another bout of exacerbation. I started Googling my symptoms because I have nasal polyps, asthma, and can’t take NSAID’S. I’ve been suffering from nasal polyps for over 15 years. I had two nasal surgeries and the my nasal polyps came back with a vengeance. My ENT Doctor has prescribed me Dupixcent. She feels that my body needs a rest
Same!
Same problem i had now my third surgery has been done. What you did after the diagnosis?
@@lalameneelyfredrich2093 It’s it an overwhelming experience. When the doctors don’t know why you keep crashing with respiratory failure and all the time they thinks it’s your heart. So they give you aspirin not knowing that’s what causing your issue. Thank God for me being pro-active and a advocate about my health. All my doctors was amazed that I found out about AERD and brought it to their attention. I’ve been on Dupixent for 14 days and I can finally breathe. No nasal obstruction and my polyps has shrunken🙌🏾🙌🏾🙌🏾
@@user-ec1qy2pk4l I am on Dupixent and it has shrunken my polyps and I can breath. I take my second injection tomorrow. I’m so nervous because I have to inject myself😱😱😱
wow very informative. thank you
If you have nasal polyps with sinusitis... It's likely your Vitamin D level. 3 research papers:
1) Vitamin D deficiency is associated with increased human sinonasal fibroblast proliferation in chronic rhinosinusitis with nasal polyps
2) Chronic rhinosinusitis with polyposis and serum vitamin D levels
3) The Correlation Between Vitamin D Deficiency and Chronic Rhinosinusitis: A Systematic Review
That's the sunshine hormone, 40% UNFILTERED skin exposure 15min a day for 3x a week is most effective. UVB is best between 10am-2pm, but then go back to using sunblock! Diet is much harder to absorb, and certain food sources are not very biologically available
Why were AFS patients excluded from trials?
Shame dupixent is horrendously expensive. If no health insurance you are stuffed. No pun intended.
Pun intended.