Chronic sinusitis: Intense medical efforts made to search for integrated treatment solutions

Hind Al Soulia - Riyadh - RIYADH — The standard treatment line of chronic rhino sinusitis with nasal polyps includes the corticosteroid which may either be the topical nasal corticosteroid that is used as first line therapy in medical management of chronic rhino-sinusitis with nasal polyps, used as nasal sprays to treat small to medium nasal polyps and to improve the sino-nasal symptoms, or the Systemic corticosteroid used as oral or injected steroids, given as short course for providing a rapid relief of facial pressure and nasal blockage by reducing mucosal edema.

It is used to control only the severe cases because it can cause various side effects such as hyperglycemia which can trigger or worsen diabetes mellitus, hypertension, mood changes a probable cause of anxiety, confusion and sleep disturbance, obesity and weight gain especially in the abdomen, face, and back of the neck, increased risk of infection with bacterial, viral or fungal infection, increased risk of osteoporosis and fractures besides increased risk of glaucoma.

The other line of treatment of chronic rhino sinusitis includes saline nasal irrigation which is used as adjunct therapy to topical nasal steroid This helps to improve the symptoms of rhino-sinusitis by rinsing the nasal cavity with saline to promote mucociliary clearance by flushing out mucous, crust and irritants inside the sinus.

The last resort will be surgery, which is recommended in cases that are resistant to medication, but it can cause numerous adverse effect as:

* Minor complications 0.4 % - 21%:

a) Periorbital emphysema

b) Hemorrhage into eyelids

c) Minor bleeding

* Major complication 0.36 % - 3.1%:

a) Major bleeding (transfusion)

b) Injury to orbital content

c) Injury to skull base

In this context, a global pharmaceutical company organized a medical scientific symposium through virtual video conferencing technology, “Video Conference” which discussed the launch of the effective biological drug, the drug approved by the Saudi Food and Drug Authority.

The effective biological drug released is fully human monoclonal antibody that is used as add on therapy with intranasal corticosteroid for treatment of adult patient with sever chronic rhino- sinusitis and nasal polyps for which therapy with systemic corticosteroids and/or surgery do not provide adequate disease control.

The biological drug is the first dual inhibitor. It acts by targeting interleukin 4 receptor alpha subunit and block the intracellular signaling of interleukin 4 and interleukin 13 that are responsible for initiating the immunological reaction of type 2 inflammation.

The recommended dose of the effective biological drug for chronic rhino sinusitis with nasal polyps in adult patient is an initial dose of 300 mg followed by 300 mg given every other week, and it is administrated by subcutaneous injection into the thigh or abdomen region, the biological drug should not be injected into tender, damaged skin or that has bruises or scars.

Regarding the clinical efficacy of the biological drug within 52 weeks. The biological drug shows improvement in sino-nasal symptoms as 54% improvement in nasal congestion and nasal obstruction at week 52,71% improvement in sense of smell, most of improvement seen at second week of treatment, 37% had improvement and significant decrease in nasal polys size at 52 weeks,76 % reduction in systemic corticosteroid use in treatment of chronic rhino sinusitis with nasal polyps over 52 weeks and 83 % reduction in need for Sino-nasal surgery through at 52 weeks.

In this framework, Prof. Osama Marglani, professor at Faculty of Medicine, Umm Al Qura University, Makkah, Consultant Otolaryngology and head & neck surgery at KFSH & RC, Jeddah, provided a rich insight into chronic rhino sinusitis that affects the nose and mucous membranes of the sinuses adjacent to the nose, leading to congestion in the sinus region and growth of appendages in the nose due to enlargement of the mucous membranes of the nose, known as nasal polyps, for a period of time exceeding 12 weeks.

Prof. Martin Wagenmann, head, rhinology, allergy, and endoscopic skull base surgery, Department of Otorhinolaryngology University, Hospital of Düsseldorf, Düsseldorf, Germany, indicated that there are reasons that call for surgery such as lack of improvement in the disease with medical treatments, the relationship between disease symptoms and results of laparoscopic surgery and radiological results, benign tumors, complications, and mucocele.

Professor Martin added that nasal polyposis causes direct economic burdens that fall under the necessity of mobilizing health care resources and other indirect problems affecting education, work and productivity.

Prof. Claus Bachert, professor and head chair, upper airway research laboratory department of Oto-Rhino-Laryngology University of Ghent, Ghent, Belgium, pointed at the reasons of the occurrence of type II infections, indicating that there are mutual roles between the second type of IL-4 / IL-13 / IL-5 and acute nasal polyposis, and He added that the effects of the new effective biological drug are comparable or better than the oral corticosteroids, as they last for a much longer period. — SG