Use of steroid-eluting stents in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP)


Anju Peters, MD: Dareen, this is for you. You do a lot of clinical trials. How can clinical trials be used 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 goes to some of your colons, in that, as I said, in some of these complicated patients with the excellent ENT medical school in my area. We will usually try one of these organic products for about 6 months. I would also like to know what you think of it, and if there is another option, we could try another. And, funny enough with these drugs, unlike asthma, which clearly states it’s complementary therapy with biologics, it’s not very clear with all biologics in terms of usage with nasal polyposis, which I find interesting because similar inflammation is the underlying. The best success is complementary therapy, which means we treat the underlying inflammation with something like EDS-FLU, along with the use of biologics. But beyond that, one of the big hurdles for us is that all these drugs, IL-4, IL-13, anti-IgE, anti-eosinophils, IL-5, are focused on this type 2 inflammation. And the deficit or lack is what about patients who don’t have type 2 inflammation, or a Sinophilic state of inflammation. And in those patients, that may be where clinical trials can be used for them, with some of the newest therapies in development. Or maybe they have this inflammation, but still have some lack of symptoms that are being addressed and still having issues. And of course, we assumed that we had prepared these patients for all the underlying diseases that we are concerned about. But we met these patients, you know, like some of the other conditions where we treated them, the polyps got better. We have much less inflammation, but the patients continue, for example, to have significant facial pain pressure. There are certainly opportunities for them to move forward with some new drugs.

Anju Peters, MD: That makes sense. We are going to switch to organic products. Naveen, you’ve talked about this before, but how do you see the role of steroid-eluting stents in the treatment of nasal polyps?

Naveen Bhandarkar, MD: Steroid-eluting stents have been a key part of my practice in the treatment of polyps over the years and generally intraoperatively I tend to use them in many patients with nasal polyps. Almost all, probably easily over 80% due to their ability to treat inflammation with steroid eluting epicytes to minimize the burden possibly of oral systemic steroids than – honestly, I used to give a lot more often in as part of surgery before steroid implants. When we look at studies of steroid implants, a 2019 meta-analysis showed that, compared to controls, the use of steroid-eluting implants reduced the need for postoperative intervention, which may include treatment of the scar tissue or lysis of adhesions. , repeated surgery, use of oral steroids, improved patency of the frontal sinus ostium in particular, and reduced polyp score. Based on the data, they certainly play a key role. Like biologics, they have a significant associated cost per implant. We must pay attention to this when deciding whether to use them intraoperatively or even postoperatively. But the data is favorable. And yes, they played a key role in the post-surgical setting. Again, we mentioned that all implants can only be used as part of surgery or postoperatively after prior surgery.

Transcript edited for clarity


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