From one biologic to another: the rationale and evidence behind switching therapies in chronic rhinosinusitis

Abstract

Purpose of review Although biologics had been used to treat CRSwNP, not all patients respond favourably, necessitating the use of other biologics. As there are currently no guidelines available, the process and rationale for switching biologic therapy in the treatment of CRSwNP are examined in this review. Recent findings Due to the heterogeneity of diseases, biologic therapies may efficiently control CRSwNP but give inadequate control for asthma, or vice versa. Changing an ineffective first-line biologic to a second-line treatment or others is generally referred to as switching. The most common reasons for switching biologics are poor symptom management or ineffectiveness, and undesirable adverse effects. The ineffectiveness was largely due to the use of omalizumab or mepolizumab, whereas the adverse effects were due to dupilumab. Summary Switching biologics is a nuanced process influenced by a variety of patient-specific and clinical factors. Biologics that effectively treat upper and lower airway diseases are recommended for optimal control in CRSwNP patients with concurrent asthma. There was no difference in outcomes between switching biologics with and without a washout period. Switching between biologics in the same class is generally not recommended. Dupilumab serves as an effective treatment option for refractory cases particularly aspirin-exacerbated respiratory disease.