Criteria for switching biologics in patients with CRSwNP – a real life study

Since 2019, biologics have been available for the treatment of CRSwNP patients with severe disease and fortunately lead to a significant improvement in symptoms and quality of life in most patients - with a limited side effect profile. In everyday clinical practice it has been observed that some patients do not show sufficient symptom improvement or develop relevant side effects. These patients may benefit from switching to a different biologic after individual evaluation. As part of our study, we examined 191 patients with CRSwNP who were treated with Dupilumab, Omalizumab or Mepolizumab at a center of maximum care over a period of 3 years. Polyp score, olfactory function (B-SIT, Sniffin' Sticks 12), SNOT-22 (Sino-Nasal-Outcome-Test-22) and a VAS (Visual Analog Scale) were surveyed both at the time of indication and during the clinical course. In 24 patients (12.5%), we observed that the antibody therapy was switched during the course of treatment. Of these, 12 patients (6%) reported intolerable side effects and 13 patients (7%) showed a lack of response. A total of 35 patients (18%) experienced side effects, with conjunctival symptoms (26%) being the most common, followed by fever attacks (14%) and pruritus (11%). Switching because of treatment failure from Dupilumab to another biologic occurred in 4 patients and from Omalizumab or Mepolizumab to Dupilumab in 9 patients. As there are no clear guidelines and predictors for the optimal choice of biologics, in some cases it is reasonable to switch to another antibody therapy in order to achieve an optimal treatment outcome. Our results suggest that the reasons for switching biologics in patients with CRSwNP are about equally divided between the occurrence of intolerable side effects and treatment failure.