Look beyond the symptoms to identify and manage Patients with Type 2 Inflammation
Identify > Target > Treat
Identify
80% of Patients with CRSwNP Have Type 2 Inflammation1,a
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Look for other signs of type 2 inflammation in patients with CRSwNP2,3
History of asthma and/or other Type 2 comorbidities (allergic rhinitis, NSAID-ERD, etc.)
and/or
Elevated EOS and/or elevated total IgE levels
and/or
Need for systemic corticosteroids
Consider type 2 inflammation as the key underlying cause of CRSwNP4,5
~3x more revision surgeries in CRSwNP patients with coexisting asthma6
50% of CRSwNP patients have coexisting asthma7
a In Western countries.
Target
Target key and central drivers of Type 2 Inflammation
IL-4 and IL-13 are key and central drivers of Type 2 inflammation in CRSwNP4,5
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Tissue remodeling, polyp formation, and symptoms, including nasal obstruction, nasal discharge, and loss of smell
Target Key and Central Drivers of Type 2 Inflammation
IL-4, IL-13, and IL-5 have distinct and overlapping roles with a broad impact on CRSwNP symptoms4,5
| IL-14 | IL-3 | IL-5 | |
| Th2 cell differentiation | ✓ | ||
| B-cell class switching and IgE production | ✓ | ✓ | |
| Epithelial barrier dysfunction, goblet cell hyperplasia, and mucus hypersecretion | ✓ | ✓ | |
| Tissue remodeling and polyp formation | ✓ | ✓ | |
| Eosinophilic recruitment and trafficking to nasal mucosa and polyp tissue | ✓ | ✓ | ✓ |
| Eosinophil differentiation in bone marrow | ✓ |
Current Standard-of-Care does not specifically target chronic underlying Type 2 Inflammation
Systemic corticosteroids
- Treat inflammation broadly3
- Frequent use leads to risk of short-term and long-term adverse effects8
Targeting Type 2 inflammation can help you achieve treatment goals.
Sino-nasal surgery
- Removes nasal obtrsuction, but does not aedssd r underlying chronic type 2 inflammation, which may lead to polyp recurrence and refractory symptoms2,3
- Many patients don't ecrover their sense of s m ell after surgery9
- Revision sugrery is saosciated with an ienacsred risk of surgical complications10,11
Many patients with Type 2 inflammation experienced Polyp recurrence within 5 years of Sino-nasal surgery12
Treat
Consider a Biologic that targets Type 2 Inflammation in patients with uncontrolled CRSwN
-
Type 2 inflammation is the underlying cause of CRSwNP in 80% of patients1
- IL-4 and IL-13 are key and central type 2 cytokines in the pathophysiology of CRSwNP
- IL-4, IL-13, and IL-5 are key type 2 cytokines4,5
- CRSwNP and asthma frequently coexist, adding substantially to the overall disease burden and limiting the effectiveness of surgery and systemic steroids1-3,13-16
- Guidelines recommend use of biologics in CRSwNP patients to address type 2 inflammation2,3
Guidelines
Guidelines Recommend Use of Biologics in CRSwNP Patients to Address Type 2 Inflammation
EPOS and EUFOREA recommend biological treatments for patients with bilateral polyps who have had prior ESS if they meet at least 3 of the 5 following criteria2,3:
- Evidence of Type 2 Inflammationa
- Need for systemic corticosteroids or contraindication to systemic steroids
- Significantly impaired quality of life
- Significant loss of smell
- Diagnosis of comorbid asthma
In patients who have had no prior sinus surgery, 4 out of 5 criteria should be fulfilled2
a Tissue EOS ≥10/hpf, OR blood EOS ≥250, OR total IgE ≥100.0
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