From the Guidelines
Nasal polyp treatment should begin with intranasal corticosteroid medications, such as fluticasone or mometasone, to reduce inflammation, and for more severe cases, oral corticosteroids like prednisone may be prescribed to rapidly shrink polyps, as recommended by the most recent guidelines 1. The treatment of nasal polyps is challenging and requires a comprehensive approach.
- The goal of treatment is to reduce inflammation, improve symptoms, and prevent recurrence.
- Intranasal corticosteroids are the first line of treatment, with options like fluticasone (Flonase) or mometasone (Nasonex) being effective in reducing nasal congestion and improving sense of smell 1.
- For more severe cases, oral corticosteroids like prednisone (typically 20-40mg daily for 5-7 days) may be prescribed to rapidly shrink polyps, as shown in studies such as Vaidyanathan 2011 and Van Zele 2010 1.
- Saline nasal irrigation using a neti pot or squeeze bottle with sterile saline solution 1-2 times daily can help clear mucus and improve medication delivery.
- Antibiotics may be needed if infection is present, and antihistamines or leukotriene modifiers like montelukast (10mg daily) may be helpful for patients with allergies contributing to polyps.
- Biologic medications such as dupilumab (Dupixent) are newer options for severe cases, especially those with concurrent asthma or aspirin sensitivity, and have been shown to be effective in reducing symptoms and improving quality of life 1.
- If medications fail, endoscopic sinus surgery can remove polyps, though recurrence is common without ongoing medical management. The most recent guidelines recommend a stepwise approach to treatment, with biologics being considered for patients who have not responded to other treatments, and emphasize the importance of shared decision-making between patients and clinicians 1.
- The choice of biologic agent should be based on the individual patient's characteristics, such as the presence of comorbidities and dual indications for a specific biologic.
- Dupilumab and omalizumab have been shown to be the most beneficial for patient-important outcomes, followed by mepolizumab, and may be preferred over other treatments in certain cases, such as in patients with AERD or EGPA 1.
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)
Chronic Rhinosinusitis with Nasal Polyps (2.5): Recommended dosage for adult and pediatric patients 12 years of age and older is 300 mg given every other week (Q2W).
Treatment options for nasal polyps include dupilumab (DUPIXENT) 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), with a recommended dosage of 300 mg given every other week (Q2W) 2.
From the Research
Treatment Options for Nasal Polyps
- Medical management of nasal polyposis aims to eliminate or reduce the size of polyps, re-establish nasal breathing, reduce symptoms of rhinitis, restore the sense of smell, and prevent the recurrence of nasal polyps 3, 4
- Topical corticosteroids are the first-line therapy for nasal polyposis and have a proven therapeutic effect on the symptoms of nasal polyposis, reducing inflammation and polyp size 5, 3, 4, 6
- Examples of effective topical corticosteroids include:
- Systemic corticosteroids may be used in severe cases or when topical corticosteroids are ineffective 4, 7
- Surgery may be considered if conservative therapy is ineffective 7
- Supportive therapy, such as lavages with sodium chloride solution, may also be utilized 7
- A combination of antibiotics and corticosteroids may be worthwhile in purulent rhinosinusitis 7