Efficacy and safety of switching between biologics in chronic rhinosinusitis with nasal polyps or N-ERD

Abstract

Background and objective: The effectiveness of biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) is well-establis- hed. However, real-world experience on the effectiveness of transitioning between two monoclonal antibodies is scarce. There- fore, we aimed to analyze the safety and efficacy of antibody switching in treatment of chronic rhinosinusitis. Methods: All patients with CRSwNP or nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD) requiring a switch between biologics were retrospectively studied. Analysis included changes in polyp size, quality of life parameters, asthma control, and side effects. Results: Out of 195 patients treated with biologics for CRSwNP or N-ERD in our center, 23 (11.8%) required transition to a different monoclonal antibody. The majority switched from omalizumab to dupilumab (17/23, 73.9%), mostly due to inadequate symptom control. Nine out of these 17 patients (52.9%) were switched without a washout period. All patients showed significant improve- ment in nasal polyp score, asthma control test and sino-nasal outcome test-22 after changing to dupilumab. Keratoconjunctivitis sicca was the side-effect (4.3%) reported after the switch from omalizumab to dupilumab, which lead to termination of therapy in one patient. Due to limited sample size, other antibody transitions were reported in a descriptive manner. Conclusion: The transition to dupilumab is an effective option in patients with inadequate treatment response or side-effects of omalizumab in nasal polyposis. Our preliminary results indicate that a wash-out period may not be necessary when switching between biologics, however, these findings require further investigations. Other monoclonal antibody transitions also show pro- mising results, but warrant validations in larger cohorts due to small patient samples in our study.