Rowan Nicholas R, Naclerio Robert M
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
J Allergy Clin Immunol Pract. 2020 May;8(5):1550-1555. doi: 10.1016/j.jaip.2020.01.049. Epub 2020 Feb 4.
The treatment paradigm for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP) is currently undergoing a rapid evolution with the development of monoclonal antibody therapies targeted at type 2 inflammatory pathways. The use of these biologic therapies in asthmatic patients, and more recently, patients with CRSwNP has produced promising results, especially for patients with severe disease. Many questions regarding the appropriate timing of these medications, whether or not these new treatment strategies should be used as a monotherapy or in conjunction with traditional therapies such as sinus surgery, the role of appropriate phenotyping, and identification of biomarkers, remain unanswered. We herein present a case of a patient with severe eosinophilic asthma and comorbid CRSwNP who failed to achieve control of his respiratory symptomology and ultimately progressed to sinus surgery despite treatment with an anti-interleukin 5 monoclonal antibody therapy (mepolizumab). Consideration is given to the mechanistic underpinnings of the reported patient's failure. This case highlights the need for further understanding of the optimal usage of these novel therapeutics in the management of CRSwNP and in the need to better understand the pathophysiology of CRSwNP.
随着针对2型炎症途径的单克隆抗体疗法的发展，伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）的治疗模式目前正在迅速演变。这些生物疗法在哮喘患者以及最近在CRSwNP患者中的应用已产生了令人鼓舞的结果，尤其是对于重症患者。关于这些药物的合适使用时机、这些新治疗策略应单独使用还是与鼻窦手术等传统疗法联合使用、合适的表型分析的作用以及生物标志物的识别等许多问题，仍然没有答案。我们在此介绍一例患有重度嗜酸性粒细胞性哮喘和合并CRSwNP的患者，尽管接受了抗白细胞介素5单克隆抗体疗法（美泊利珠单抗）治疗，但仍未能控制其呼吸道症状，最终进展为鼻窦手术。文中对所报道患者治疗失败的机制基础进行了思考。该病例凸显了进一步了解这些新型疗法在CRSwNP管理中的最佳使用方法以及更好地理解CRSwNP病理生理学的必要性。
