Comparison of Biologics in the Treatment of Chronic Rhinosinusitis with Nasal Polyps
The authors of a meta-analysis of nine randomized controlled trials comparing dupilumab, omalizumab, and mepolizumab in patients with chronic rhinosinusitis and nasal polyps attempted to identify the most advantageous of the available biologics for this indication based on the ratio of benefits to risks.
Evaluated Studies
Biologic drugs have been proven effective in reducing the volume of nasal polyps in patients with chronic rhinosinusitis when compared to placebo. However, a direct comparison of individual products was lacking until now. The authors of the work published in October 2021 conducted a systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases up to December 29, 2020. They searched for randomized controlled trials evaluating biologics in the treatment of adult patients with chronic rhinosinusitis and nasal polyps and conducted a network meta-analysis.
Their evaluation included nine studies encompassing a total of 1,190 patients, comparing three biologics (dupilumab, omalizumab, and mepolizumab) to placebo.
Results
The best efficacy in terms of the Nasal Polyp Score (NPS), Nasal Congestion Score (NCS), Sino-Nasal Outcome Test-22 (SNOT-22) score, and University of Pennsylvania Smell Identification Test (UPSIT) was shown by dupilumab. Omalizumab was second in terms of improvements in SNOT-22, UPSIT, and NCS scores, while mepolizumab showed improvements in NPS.
The highest incidence of adverse events was found with mepolizumab.
Conclusion
This first network meta-analysis providing indirect comparisons of biologic treatments in adult patients with chronic rhinosinusitis and nasal polyps showed that the best choice in terms of efficacy and safety is dupilumab, with omalizumab recommended as a second option.
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Source: Wu Q., Zhang Y., Kong W. et al. Which is the best biologic for nasal polyps: dupilumab, omalizumab, or mepolizumab? A network meta-analysis. Int Arch Allergy Immunol 2022; 183 (3): 279−288, doi: 10.1159/000519228.
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