Biological treatment in chronic rhinosinusitis: the current state of knowledge

Biological treatment is a modern method of therapy that has recently found its application in the treatment of type 2 chronic rhinosinusitis (CRS) associated with eosinophilic inflammation and the Th2-dependent inflammatory reaction (involving interleukins 4, 5 and 13). The aim of the article is to present the current state of knowledge regarding the use of biological treatment as a new therapeutic option for patients with treatment-resistant CRS with nasal polyps. Biologics are monoclonal antibodies that help suppress abnormal responses by the immune system. They are widely used in neoplastic, inflammatory and allergic diseases. Currently, biological drugs can also be used in patients with CRS and include monoclonal antibodies directed against interleukin 4 receptors (dupilumab), interleukin 5 (benralizumab) and directly blocking interleukin 5 itself (mepolizumab, reslizumab) or free immunoglobulin E (omalizumab). In 2019, the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved dupilumab for the treatment of CRS with nasal polyps. In Poland, none of the biological drugs has been included in the refunded list in the CRS treatment, and the high costs of treatment limit the possibility of using this therapeutic option by the majority of patients.