Evaluation of switching or simultaneous use of biologic treatment in patients with severe chronic rhinosinusitis with nasal polyps and severe asthma. Considerations in clinical decision making

INTRODUCTION Type 2 targeting biologics have reached the market first for asthma and since 2019 also for CRSwNP. As clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal treatment result. In this paper, we evaluate reasons for switching biologics and the treatment effects after each sequential switch. MATERIALS AND METHODS 94 patients who switched from one biologic to another for their treatment of CRSwNP and asthma were evaluated. RESULTS 20 patients experienced satisfactory control of CRSwNP, but insufficient control of severe asthma. 51 patients experienced satisfactory control of severe asthma, but insufficient control of CRSwNP/EOM. 28 patients experienced insufficient control of both upper and lower airways. 13 patients had to switch because of side effects. Furthermore, two cases are described to clarify clinical decision making. DISCUSSION For abovementioned patients, a multidisciplinary approach is mandatory to find the best suitable biologic. It seems ineffective to switch to a second anti-IL5 treatment if the first one is not successful. Most patients that failed omalizumab and/or an anti-IL-5 treatment are well controlled on dupilumab. Therefore we suggest to use dupilumab as first choice when switching biologic agents.