Key result
Endoscopic sinus surgery achieves clinical remission in ~49% of CRSwNP patients, with AERD predicting failure.
Why the study?
There is a paradigm shift towards disease modification and remission as a treatment goal in refractory eosinophilic diseases with type 2 inflammation, but this concept is novel and evolving in these conditions including CRSwNP.
Cohort (n=569)
No
Clinical remission in CRSwNP after endoscopic sinus surgery consists of distinct endoscopic and symptom components that have different preoperative predictors, with aspirin-exacerbated respiratory disease (AERD) being a strong marker for failure in both.
Surgery's limited simultaneous control in CRSwNP warrants caution, especially with AERD; leaves open whether biologics can establish remission as a realistic target.
Refractory eosinophilic diseases characterized by type 2 inflammation, including branchial asthma, allergic rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis, food allergies and eosinophilic esophagitis, are increasing in prevalence worldwide.Currently, there is a major paradigm shift and cutting edge in the management of these diseases, towards the concept of disease modification and the treatment goal remission, regardless of severity and age.Remission as a treatment goal in chronic inflammatory diseases was first introduced in rheumatoid arthritis, and then adopted in other non-type 2 inflammatory diseases.Among diseases with type 2 Inflammation, this concept is novel and currently most advanced in asthma.This new paradigm has been developed based on a better understanding of the pathophysiology of type 2 inflammation and the advent of highly effective drugs selectively interfering with type 2 pathways.Here, we review the evolution of the new remission concepts in type 2 inflammatory diseases including eosinophilic rhinosinusitis with nasal polyps and discuss associated challenges and future research needs.
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Kawauchi et al. (2026) conducted a cohort in Chronic rhinosinusitis with nasal polyps (CRSwNP) (n=569). Endoscopic sinus surgery (ESS) was evaluated on Simultaneous clinical remission (endoscopic control and symptom control). Endoscopic sinus surgery resulted in simultaneous endoscopic and symptom control in 49% of CRSwNP patients, with aspirin-exacerbated respiratory disease being the strongest predictor of failure.
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