Use of Steroid Eluting Stents in Treatment of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)

Anju Peters, MD: Dareen, this is for you. You do a lot of clinical trials. How do use clinical trials for patients, who for example, have stopped responding to their current treatment? Do you offer them other clinical trials?

Dareen Siri, MD, FAAAAI, FACAAI: My answer transitions to some of both of your points, in that, as I discussed, in some of these complicated patients with the excellent ENTs school of medicine in my area. We typically will try one of these biologics for about 6 months. I would like to see what you guys are thinking about that as well, and certainly if there's another option, we might try a different one. And, funny enough with these medications, unlike asthma, which clearly states this is an add on therapy with biologics, that's not very clear with all the biologics in terms of the use with nasal polyposis, which I find interesting because that the similar inflammation is underlying it. The best success is add-on treatment, meaning that we're addressing the underlying inflammation with something like EDS-FLU, as well as the use of biologics. But beyond that, one of the big barriers for us is that all these medications, IL-4, IL-13, anti-IgE, anti-eosinophils, IL-5, is that they are focused on that type 2 inflammation. And the deficit or the lack is that what about those patients who do not have a type 2 inflammation, or a sinophilic inflammation status. And in those patients, perhaps, that where is where the clinical trials may be utilized for them, with some of the newer developing therapies. Or perhaps, they do have that inflammation, but they are still having some lack of symptoms that are being addressed, and are still feeling some issues. And of course, we've assumed that we've worked these patients up for all the underlying diseases that we're worried about. But we have encountered these patients, you know, like some of the other disease states where we've treated them, the polyps have improved. We have much less inflammation, but the patients continue, for example, to have significant facial pain pressure. There are certainly opportunities for them going forward for some newer medications.

Anju Peters, MD: That makes sense. We will move on from biologics. Naveen, you discussed this previously, but how do you see the role of steroid-eluting stents in the treatment of nasal polyps?

Naveen Bhandarkar, MD: Steroid-eluting stents have played a key role in my practice in treatment of polyps over the years now, and generally speaking, intraoperatively, I tend to use them in many patients with nasal polyps. Almost all, probably easily over 80% because of their ability to treat inflammation with eluting steroid epicyte to minimize the burden possibly of oral systemic steroids that - honestly, I used to give a lot more commonly in the setting of surgery before steroid implants. When we look at the studies on steroid implants, a meta-analysis that was performed in 2019 showed that compared to controls, the use of steroid-eluting implants decreased the need for post operative intervention, which can include scar tissue treatment, or adhesion lysis, repeat surgery, oral steroid use, improved patency of the frontal sinus ostium in particular, and reduced polyps score. Based on the data, they definitely play a key role. Like biologics, they do have an associated - significant associated cost per implant. We do need to pay attention to that when we make decisions on using those intraoperatively or even postoperatively. But the data is favorable. And yes, they have played a key role in the post-surgical setting. Again, we mentioned that all the implants can only be used in the setting of surgery or postoperatively after prior surgery.

Transcript edited for clarity