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Purpose: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease of the upper airways, encompassing distinct endotypes and phenotypes. Among these, chronic rhinosinusitis with nasal polyps (CRSwNP) frequently involves type 2 inflammation and tends to recur despite conventional treatments. This review aims to summarize current pharmacologic strategies for CRS management, with a focus on the emerging role of biologics as precision medicine.

Current Concepts: Standard pharmacologic treatments for CRS include saline irrigation, intranasal corticosteroids, short-term systemic steroids, macrolide antibiotics, leukotriene antagonists, and, in select cases, bacterial lysates. These therapies target mucosal inflammation and symptom relief, often serving as adjuncts to endoscopic sinus surgery. Recently, biologics such as dupilumab, omalizumab, and mepolizumab have been approved for CRSwNP, offering targeted inhibition of the interleukin (IL)-4/IL-13, immunoglobulin E, and IL-5 pathways, respectively. Clinical trials and real-world studies have demonstrated their efficacy in reducing polyp size, improving quality of life, restoring olfaction, and reducing the need for surgery in type 2 inflammation-dominant CRSwNP.

Discussion and Conclusion: Biologics represent a paradigm shift in the management of CRS, particularly in refractory CRSwNP. However, issues regarding cost, insurance coverage, optimal treatment duration, and criteria for switching or discontinuation remain unresolved. Future research should focus on identifying predictive biomarkers, establishing practical guidelines specific to Korea, and validating the real-world cost-effectiveness of these guidelines. A personalized treatment strategy based on endotype classification, that integrates pharmacologic and biologic therapies, may improve long-term outcomes in patients with CRS.

Purpose: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease of the upper airways, encompassing distinct endotypes and phenotypes. Among these, chronic rhinosinusitis with nasal polyps (CRSwNP) frequently involves type 2 inflammation and tends to recur despite conventional treatments. This review aims to summarize current pharmacologic strategies for CRS management, with a focus on the emerging role of biologics as precision medicine.

Current Concepts: Standard pharmacologic treatments for CRS include saline irrigation, intranasal corticosteroids, short-term systemic steroids, macrolide antibiotics, leukotriene antagonists, and, in select cases, bacterial lysates. These therapies target mucosal inflammation and symptom relief, often serving as adjuncts to endoscopic sinus surgery. Recently, biologics such as dupilumab, omalizumab, and mepolizumab have been approved for CRSwNP, offering targeted inhibition of the interleukin (IL)-4/IL-13, immunoglobulin E, and IL-5 pathways, respectively. Clinical trials and real-world studies have demonstrated their efficacy in reducing polyp size, improving quality of life, restoring olfaction, and reducing the need for surgery in type 2 inflammation-dominant CRSwNP.

Discussion and Conclusion: Biologics represent a paradigm shift in the management of CRS, particularly in refractory CRSwNP. However, issues regarding cost, insurance coverage, optimal treatment duration, and criteria for switching or discontinuation remain unresolved. Future research should focus on identifying predictive biomarkers, establishing practical guidelines specific to Korea, and validating the real-world cost-effectiveness of these guidelines. A personalized treatment strategy based on endotype classification, that integrates pharmacologic and biologic therapies, may improve long-term outcomes in patients with CRS.

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기사명 저자명 페이지 원문 목차
만성 비부비동염의 역학 및 진단 = Epidemiology and diagnosis of chronic rhinosinusitis 이영하, 채희성, 이은정 p. 404-412
만성 비부비동염의 치료 = Surgical management of chronic rhinosinusitis : a narrative review : 수술적 치료를 중심으로 전영진 p. 417-426
만성 비부비동염의 치료 = Medications and new therapies for chronic rhinosinusitis : a narrative review : 약물치료 및 새로운 치료법을 중심으로 박상철 p. 427-435
난치성 비부비동염의 치료 = Treatment of refractory rhinosinusitis : a narrative review 조재훈 p. 436-441
정맥혈전증 환자의 수술 전후 직접 경구 항응고제 관리 전략 = Clinical strategies for perioperative management of direct oral anticoagulants in patients treated for venous thromboembolism 황헌규, 석진우, 김양기 p. 442-448
중증 천식의 약물치료 = Therapeutics for severe asthma 안진, 김상헌 p. 451-458
Cause-of-death statistics in Korea from 2021 = 우리나라 2021년도 사망원인통계 Junghyun Oh, Juhee Seo, Seokmin Lee, Youngil Lim p. 459-471

참고문헌 (47건) : 자료제공( 네이버학술정보 )

참고문헌 목록에 대한 테이블로 번호, 참고문헌, 국회도서관 소장유무로 구성되어 있습니다.
번호 참고문헌 국회도서관 소장유무
1 Is montelukast indicated for treatment of chronic rhinosinusitis with polyposis? 미소장
2 Topical steroid for chronic rhinosinusitis without polyps 미소장
3 Macrolide therapy of chronic rhinosinusitis. 미소장
4 The effectiveness topical amphotericin B in the management of chronic rhinosinusitis: a meta-analysis 미소장
5 A Double-Blind Randomized Controlled Trial of Normal Saline, Lactated Ringer's, and Hypertonic Saline Nasal Irrigation Solution after Endoscopic Sinus Surgery 미소장
6 Intranasal Steroids and the Myth of Mucosal Atrophy: A Systematic Review of Original Histological Assessments 미소장
7 Efficacy and safety of mometasone furoate nasal spray in the treatment of chronic rhinosinusitis 미소장
8 A Double‐Blind, Randomized, Placebo‐Controlled Trial of Macrolide in the Treatment of Chronic Rhinosinusitis 미소장
9 A randomized trial of mupirocin sinonasal rinses versus saline in surgically recalcitrant staphylococcal chronic rhinosinusitis 미소장
10 Mometasone furoate nasal spray in the treatment of nasal polyposis in Chinese patients: a double‐blind, randomized, placebo‐controlled trial 미소장
11 Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis 미소장
12 Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers 미소장
13 Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis 미소장
14 RESOLVE: bioabsorbable steroid‐eluting sinus implants for in‐office treatment of recurrent sinonasal polyposis after sinus surgery: 6‐month outcomes from a randomized, controlled, blinded study 미소장
15 Long-term Postoperative Azithromycin in Patients with Chronic Rhinosinusitis: A Randomized Clinical Trial 미소장
16 Effect of Sodium Hyaluronate Added to Topical Corticosteroids in Chronic Rhinosinusitis with Nasal Polyposis 미소장
17 Post‐operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta‐analysis 미소장
18 Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double‐blinded placebo‐controlled trial for chronic rhinosinusitis after sinus surgery 미소장
19 Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis 미소장
20 Effect of Postoperative Xylitol Nasal Irrigation on Patients with Sinonasal Diseases 미소장
21 Thiol-Based Drugs in Pulmonary Medicine: Much More than Mucolytics 미소장
22 Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps 미소장
23 Latest developments on topical therapies in chronic rhinosinusitis 미소장
24 European Position Paper on Rhinosinusitis and Nasal Polyps 2020 미소장
25 Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper 미소장
26 Use of endotypes, phenotypes, and inflammatory markers to guide treatment decisions in chronic rhinosinusitis 미소장
27 Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials 미소장
28 International consensus statement on allergy and rhinology: rhinosinusitis 2021 미소장
29 Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial 미소장
30 Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis 미소장
31 Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults 미소장
32 Mechanisms and pathogenesis of chronic rhinosinusitis 미소장
33 Therapeutic Strategies of Biologics in Chronic Rhinosinusitis: Current Options and Future Targets 미소장
34 Effect of Dupilumab on Blood Eosinophil Counts in Patients With Asthma, Chronic Rhinosinusitis With Nasal Polyps, Atopic Dermatitis, or Eosinophilic Esophagitis 미소장
35 Interpretation of Clinical Efficacy of Biologics in Chronic Rhinosinusitis With Nasal Polyps via Understanding the Local and Systemic Pathomechanisms 미소장
36 Doxycycline Improves Quality of Life and Anosmia in Chronic Rhinosinusitis With Nasal Polyposis: A Randomized Controlled Trial 미소장
37 A real-life comparison of pulmonary and nasal outcomes in patients with severe asthma and nasal polyposis treated with T2-biologics 미소장
38 EPOS/EUFOREA update on indication and evaluation of Biologics in Chronic Rhinosinusitis with Nasal Polyps 2023 미소장
39 Inflammatory Endotypes of Chronic Rhinosinusitis in the Korean Population: Distinct Expression of Type 3 Inflammation 미소장
40 Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real‐life study (DUPIREAL) 미소장
41 The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis 미소장
42 Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months 미소장
43 Diverse Endotypes of Chronic Rhinosinusitis and Clinical Implications 미소장
44 Efficacy of EDS-FLU for Chronic Rhinosinusitis: Two Randomized Controlled Trials (ReOpen1 and ReOpen2) 미소장
45 Endotype and Phenotype Related Postoperative Effects of Bacterial Lysate in Chronic Rhinosinusitis 미소장
46 Efficacy and Safety of Biologics for Chronic Rhinosinusitis With Nasal Polyps: A Meta‐Analysis of Real‐World Evidence 미소장
47 Biologics for Chronic Rhinosinusitis With Nasal Polyps: Current Status and Clinical Considerations in Korea 미소장

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