Nasal polyposis, personalized therapy limits recurrences

“Chronic rhinosinusitis with nasal polyps is a frequent inflammatory disease that affects 4-5% of the population, explains Carlo Antonio Leone, President SIOeChCF, Italian Society of Otolaryngology and Cervicofacial Surgery, and has a high impact on patients’ quality of life having nasal obstruction with subsequent difficulty breathing and loss of olfactory-gustatory function as the main symptoms. Diagnosis is simple, but its treatment remains a challenge for the otolaryngologist given the still poor knowledge of its causes, difficult therapeutic control, and the frequency of recurrence, which occurs in at least 1 in 4 patients. Although medical therapy controls symptoms in a good percentage of patients, many resort to surgical treatment to reduce complaints and prevent complications. It should be remembered, however, that the surgical approach is limited to disconstructing the nose and enlarging the sinus ostia, restoring respiratory function as best as possible and allowing nebulized drugs to reach the sinus mucosa, but it is not decisive as it does not act on the causes of the disease.”.

“In the study recently published in Acta Otorhinolaryngologica Italica,” continues Matteo Gelardi, President of the Italian Academy of Rhinology (IAR), Head of the Rhinology Center of the University Polyclinic of Bari and signatory of the study, we have established a treatment scheme aimed at controlling symptoms and improving patients’ quality of life, based on the Clinical-Cytological Grading (CCC) classification that takes into account several parameters (nasal cytology, asthma, allergies, and sensitivity to acetylsalicylic acid) as risk factors for post-surgical recurrence. This individualized treatment avoids exposing the patient to the risk of under- or over-treatment and consequently the possibility of incurring a recurrence or the side effects of the drugs used.

A total of 204 patients with chronic rhinosinusitis with nasal polyps of whom 120 had previously undergone surgery to remove the polyps were studied for 5 years. Patients were treated with topical corticosteroids with varying period of administration depending on the level of risk of recurrence and with systemic corticosteroids combined with nasal irrigations and high molecular weight hyaluronic acid.

Other medications such as antihistamines, antibiotics, and specific immunotherapies were added depending on the presence of co-morbidities such as allergic rhinitis, asthma, or concomitant infections. It was found that: in the mild risk group, 92% of patients had no worsening and did not resort to surgery; in the moderate risk group, 44% of patients had no worsening and only 3.6% needed surgery versus 13.6% in the control group; finally, only 5.7% of patients in the severe risk group needed surgical treatment versus 49% in the control group. In addition, objectively, the size of nasal polyps tended to increase at a faster rate in the control group than in patients treated with personalized therapy.

While the activity of corticosteroids in polyposis was already known, what was new was the use of 0.3% high-molecular-weight hyaluronic acid (Yabro®), which played a decisive role in its anti-infective activity on biofilms and restoration of ciliary beat”.

“This study paves the way for the development and adoption of a new approach to the management of chronic rhinosinusitis with nasal polyps on the basis of a clinical and cytological classification that allows accurate estimation of disease severity and adaptation of treatment in order to better inform the patient, improve therapeutic adherence, disease control, and limit the use of surgery,” adds Carlo Antonio Leone.

“This new approach,” Gelardi concludes, “incontrovertibly reveals that each nasal polyposis is different from the other, and in this field as in others, precision medicine is the answer to treating these patients who will have to accept and understand the chronic nature of their pathology and be willing to follow the indications that allow for good control.”.