Endotype-driven care pathways in patients with chronic rhinosinusitis - 04/05/18

Doi : 10.1016/j.jaci.2018.03.004

Claus Bachert, MD, PhD ^a,^b,^⁎ , Nan Zhang, MD, PhD ^a, Peter W. Hellings, MD ^c, Jean Bousquet, MD, PhD ^d
^a Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium
^b Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden
^c Department of Oto-Rhino-Laryngology, Leuven University Hospital, Leuven, Belgium
^d CHU Montpellier, Montpellier, France

^∗Corresponding author: Claus Bachert, MD, PhD, Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.Upper Airways Research Laboratory and Department of Oto-Rhino-LaryngologyGhent University and Ghent University HospitalC. Heymanslaan 10Ghent9000Belgium

Abstract

Information for Category 1 CME Credit

Credit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.

Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.

Date of Original Release: May 2018. Credit may be obtained for these courses until April 30, 2019.

Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.

Target Audience: Physicians and researchers within the field of allergic disease.

Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

List of Design Committee Members: Claus Bachert, MD, PhD, Nan Zhang, MD, PhD, Peter W. Hellings, MD, and Jean Bousquet, MD, PhD (authors); Zuhair K. Ballas, MD (editor)

Disclosure of Significant Relationships with Relevant Commercial

Companies/Organizations: C. Bachert is a board member for and has received a consultation fee or honorarium from Sanofi, GSK, Novartis, and Allakos; and has received money for writing or reviewing the manuscript from Sanofi. J. Bousquet is on the advisory board for and/or has received consultancy fees from and/or has received honoraria for meeting lectures from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva, and Uriach; and has shares in Kyomed. The rest of the authors declare that they have no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.

Activity Objectives:

1.	To understand the role of type 2 inflammation in patients with chronic rhinosinusitis.
2.	To describe the use of biologics in the treatment of chronic rhinosinusitis.
3.	To understand biomarkers involved in chronic sinus inflammation.

Recognition of Commercial Support: This CME activity has not received external commercial support.

List of CME Exam Authors: Andrew Abreo, MD, Christine Rukasin, MD, Cosby Stone, Jr, MD, MPH, and R. Stokes Peebles, MD.

Disclosure of Significant Relationships with Relevant Commercial

Companies/Organizations: The exam authors disclosed no relevant financial relationships.

Chronic rhinosinusitis (CRS) has been differentiated clinically into CRS without nasal polyps and CRS with nasal polyps, with both forms subjected to glucocorticosteroid and antibiotic treatments and, if not successful, to nasal and sinus surgery tailored to endoscopic and computed tomographic scan findings. The elaboration of endotypes based on pathomechanisms involving different immune responses offers new possibilities in terms of prediction of prognosis and risks and sophisticated guidance in personalized pharmacotherapy, surgical approaches, and innovative treatment approaches in the CRS field with various biologics. Surgical approaches can vary from classical functional endoscopic sinus surgery to extended and “reboot” approaches, with the idea to completely remove the dysfunctional and inflamed mucosa and replace it with a newly grown healthy mucosa. Biologics in this field are targeting the type 2 cytokines IL-4, IL-5, and IL-13, as well as IgE. Phase I and II study results are promising, and phase III studies are currently being performed. The development of endotype-driven integrated care pathways appreciating these innovations are now needed for the management of CRS.

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Key words : Chronic rhinosinusitis, nasal polyps, pharmacotherapy, surgery, biologics, endotypes, type 2 inflammation, integrated care pathways

Abbreviations used : CRS, CRSsNP, CRSwNP, CT, ICP, ILC2, SE-IgE