Nasal saline irrigation, functional endoscopic sinus surgery (FESS), and topical and oral corticosteroids are currently the standard of care (SOC) for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Biologic agents that target key effectors of type 2 inflammation were recently approved to be used as a supplement to treatment for people with severe and uncontrolled CRSwNP. Given the lack of real-world evidence, Health Care Providers (HCPs) will benefit from a better understanding of biologic use in relation to patient characterization, SOC, and other predictors.
In a poster titled “Real-world biologic use in patients with nasal polyps,” presented at the recent American Rhinologic Society Meeting in Philadelphia (Sep 9-10, 2022, researchers from GSK and IBM reported their findings. This study looked at the patient demographics, clinical characteristics, and use of healthcare resources among biologics users and non-users. The goal was to learn more about the patterns and predictors of biologic use among CRSwNP patients in relation to SOC.
This retrospective cohort study was conducted between June 2018 – June 2019 using the MarketScan Commercial Database. Patients over the age of 18 with CRSwNP non-diagnosis claims were enrolled. They were divided into two groups: those who had NP surgery and those who did not. The primary outcomes were demographics such as age and gender, comorbidity, and OCS use during biologic treatment.
The results show that only a small number of CRSwNP patients (642/5977) got biologics. More females received biologics and fewer people who didn’t get biologics needed diagnostic services. In contrast, biologic users were more likely than non-users to need services related to their drugs, whether or not they had surgery. Biologic users had more comorbid conditions, particularly asthma, allergic rhinitis, and chronic sinusitis, than non-users.
During the observation period, surgery was relatively infrequent. Biologic users who had surgery had the same biologic claims as those who did not but were on treatment for fewer days and used OCS much less. Also, among the surgery patients, biologic use was infrequent, but earliest use was numerically higher before surgery than after. The mean number of days between the first biologic use and the first NP surgery was 277.8. At the same time, it was only 91.4 days between the first NP surgery and the first biologic use after surgery, indicating a shorter gap between the first biologic use after surgery than before. The average biologic use occurred three months after surgery, possibly to improve surgical outcomes or prevent NP recurrence.
In terms of prognosis, the study found that being under 65, having certain other health problems, and getting treatment with OCS and doxycycline were all predictors of biologic use. Comorbid asthma was by far the strongest predictor of biologics use among them. This is consistent with the EPOS 2020 or EUFOREA 2021 criteria for selecting patients for biologic therapy. These findings also point to biologic use for asthma rather than CRSwNP as the primary indication. Future research into the long-term patterns and real-world clinical outcomes of biologic use in CRSwNP, as well as biologic use alignment with guideline recommendations, may help to inform and optimize patient care.