From the Guidelines
The primary treatment for nasal polyps is medical management using intranasal corticosteroids, with a short course of oral corticosteroids and biologics considered for more severe cases or those with comorbidities, as recommended by the most recent guidelines 1.
Treatment Options
- Intranasal corticosteroids: Start with a nasal spray such as fluticasone (Flonase) or mometasone (Nasonex), using 1-2 sprays in each nostril once or twice daily as directed, for at least 3-6 months to assess effectiveness.
- Oral corticosteroids: For more severe cases, a short course of oral corticosteroids may be prescribed, typically prednisone 20-40 mg daily for 5-7 days, as shown to be effective in reducing symptoms and polyp size 1.
- Biologics: Dupilumab, omalizumab, and mepolizumab may be considered for patients with high baseline disease severity or those who have not sufficiently benefitted from other treatments, as they have been shown to provide higher certainty and magnitude of benefits 1.
- Saline nasal rinses: Using a neti pot or squeeze bottle can help clear mucus and improve medication delivery.
- Endoscopic sinus surgery: May be recommended to remove the polyps if symptoms persist despite maximal medical therapy.
Considerations
- Comorbidities: Patients with comorbid diseases, such as atopic dermatitis or asthma, may benefit from specific biologics, such as dupilumab, which can improve both conditions.
- AERD: Biologics may be preferred over ATAD in patients with AERD, especially for those who have increased risk of harm with ATAD.
- Patient preferences: Patients with low disease burden may prefer to avoid the burden of systemic therapy with a biologic and its associated payment and insurance negotiation, and accept the lower certainty for modest benefits and less-invasive nature of INCS.
From the FDA Drug Label
DUPIXENT is an interleukin-4 receptor alpha antagonist indicated: ... Chronic Rhinosinusitis with Nasal Polyps as an add-on maintenance treatment in adult and pediatric patients aged 12 years and older with inadequately controlled chronic rhinosinusitis with nasal polyps (CRSwNP). (1.3)
- Treatment Option: Dupilumab (DUPIXENT) is indicated as an add-on maintenance treatment for adult and pediatric patients aged 12 years and older with inadequately controlled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP).
- Dosage: The recommended dosage for adult and pediatric patients 12 years of age and older is 300 mg given every other week (Q2W) 2.
- Key Point: Dupilumab is used as an add-on maintenance treatment, meaning it is used in addition to other treatments, not as a replacement for them.
From the Research
Treatment Options for Nasal Polyps
The treatment options for nasal polyps include:
- Medical management using topical corticosteroids, such as fluticasone propionate 3, 4, beclomethasone dipropionate 4, 5, budesonide 5, and mometasone furoate 6
- Surgical interventions, such as polypectomy or endoscopic surgery, which may be necessary in severe cases or when medical treatment fails 5, 7
- Systemic corticosteroids, which may be used for a short period to reduce inflammation and improve symptoms 7
Topical Corticosteroids
Topical corticosteroids are the medical treatment of choice for nasal polyps and have been shown to:
- Reduce polyp size and rhinitis symptoms 3, 4, 5, 6
- Improve nasal breathing and sense of smell 4, 7, 6
- Delay the recurrence of polyps after surgery 5
- Be well-tolerated and safe for long-term use 3, 4, 6
Specific Topical Corticosteroids
Specific topical corticosteroids that have been studied for the treatment of nasal polyps include:
- Fluticasone propionate, which has been shown to be effective in reducing polyp size and improving symptoms 3, 4
- Mometasone furoate, which has been shown to be effective in reducing polyp size and improving symptoms, including congestion/obstruction and loss of smell 6
- Beclomethasone dipropionate, which has been shown to be effective in reducing polyp size and improving symptoms, and may have a faster onset of action than fluticasone propionate 4