Biologics in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis in Canada: Current Trends and Practice Patterns.

Objectives: As the understanding of the pathophysiology of chronic rhinosinusitis has increased over the last few years, it has been discovered that biologic therapy targeting type 2 inflammatory molecules can be beneficial for those with difficult-to-treat chronic rhinosinusitis with nasal polyposis. Given the recency of biologics, there is somewhat limited evidence on when to prescribe these medications and who should receive them. A recent consensus paper published by a group of Canadian rhinologists gave recommendations regarding prescribing biologics to patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This study aimed to outline current practices and prescribing patterns of biologics for chronic rhinosinusitis in Canada and contrast this to existing guidelines.

Materials/methods: An online survey was distributed to members of the Canadian Rhinology Group of the Canadian Society of Otolaryngology-Head and Neck Surgery. The survey contained 44 questions, with 17 questions covering various topics related to criteria for initializing biologic therapy, investigations ordered prior to initialization of a biologic, and follow-up schedules. The responses were subsequently compared to clinical guidelines.

Results: Twenty-one physicians responded to the survey. One response was discarded for this analysis as the respondent did not prescribe biologics. The biologic agent of choice for the majority of physicians (85%) was Dupilumab (Dupixent). The most used patient-reported outcome measure used was the SNOT-22 (80%), and most physicians (90%) confirm that their patients have undergone adequate sinus surgery with a computed tomography (CT) scan prior to considering biologic therapy. Investigations ordered prior to therapy and follow-up schedules varied. Only 10% of respondents consistently refer their patients to a multidisciplinary clinic prior to prescribing biologics despite recommendations in guidelines, but 70% involve an allergist and/or a respirologist in the care of these patients.

Conclusions: Most respondents follow the recommendations made by the Canadian and international guidelines [European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)]. The lack of multidisciplinary clinics across the country could be contributing to the low number of physicians using this resource for their patients despite recommendations. As our knowledge about biologics and CRSwNP improves, and with updated guidelines recently published, this survey should be expanded and repeated in the future to revaluate biologic prescribing practices in Canada.