Treatment for CRSwNP

Commonly used treatments for CRSwNP include:

Nasal irrigation with saline: Daily flushing of the nasal passages with salt water can help remove mucus and relieve symptoms¹
Intranasal corticosteroids: These medications are applied topically to the nasal passages via a spray or other delivery system to reduce inflammation¹
Oral corticosteroids: Oral medication to reduce inflammation that can be given for a short time to reduce severe symptoms¹. Oral corticosteroids should not be taken more often than necessary because they can lead to long-term side effects¹
Sinus surgery: Functional endoscopic sinus surgery (FESS) is a surgical procedure to remove nasal polyps and open up the sinuses¹^,2
Biologic therapies: Medications administered via injection or infusion that reduce inflammation by targeting key molecules involved in the inflammatory pathways of CRSwNP^3,4

The primary goals of CRSwNP treatment are to reduce symptoms and increase quality of life¹. In the initial stages of treatment, your doctor will likely recommend nasal irrigation with saline and intranasal corticosteroids (INCS).^1,2

Nasal irrigation is a low-risk treatment that you can incorporate into your daily routine¹. Many irrigation devices and saline solutions can be purchased without a prescription.¹ Make sure to use distilled, sterilized, or boiled water for nasal irrigation to avoid infection.⁵

Intranasal corticosteroids (INCS) are usually the first treatments recommended for patients with symptoms of CRSwNP^1,2. Common methods for administering INCS treatment include sprays and an exhalation delivery system (EDS).¹
- Nasal sprays are usually the first choice for INCS treatment¹. Some are available without a prescription¹. Side effects include irritation of the nasal mucous membranes and nose bleeds.¹ If INCS nasal spray is not effective after several months, your doctor may recommend a different delivery method¹. This is because nasal sprays do not always reach the areas of the nasal passages where polyps form¹.

- The EDS device has a flexible mouthpiece and a sealed nosepiece¹. It delivers medication while you breathe out¹. EDS can be more convenient for patients who travel frequently or patients who have increased symptoms with nasal irrigation¹. Side effects of EDS use include reddening of the nasal mucous membranes, the formation of ulcers on the nasal septum, and nose bleeds. EDS can increase the risk of eye conditions such as glaucoma and cataracts¹. If you use EDS, you should be seen by the eye doctor each year to monitor for these conditions¹.

If your CRSwNP symptoms are not adequately treated with nasal irrigation and INCS, your doctor may recommend additional treatments including surgery or biologics¹.

Sinus surgery: The goals of functional endoscopic sinus surgery are to remove polyps and open up the sinuses to improve the effectiveness of topical treatments^1,2. The risks of surgery include the need for general anesthesia, infection, and injury to the areas near the operation². Surgery is not a cure for CRSwNP, and the disease will still need to be managed with medication afterwards^1,2. Symptoms return in 15%-20% of patients within 5 years of surgery⁹
Biologics: Three biologic treatments are FDA-approved for CRSwNP: dupilumab, omalizumab, and mepolizumab^1,9,10. Three other treatments are FDA-approved for other conditions and under consideration for CRSwNP treatment^1,9. These biologics may also be used for other conditions, such as asthma¹. Biologic treatments are typically given as injections or infusions⁴. Common side effects for the FDA-approved biologics for CRSwNP include headache, nose bleeds, and inflammation of the nasal passages.^10-12 Each medication has risks and benefits that can be discussed with your doctor^,2
For patients with uncontrolled CRSwNP, there are a growing number of treatment options available². You should discuss these options with your doctor to determine the best treatment for you²

References

Buccheit K, Holbrook E. Chronic rhinosinusitis with nasal polyposis: management and prognosis. UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-with-nasal-polyposis-management-and-prognosis
Ramkumar SP, Lal D, Miglani A. Considerations for shared decision-making in treatment of chronic rhinosinusitis with nasal polyps. Front Allergy. 2023;4:1137907.
Burmester, GR. Overview of biologic agents in the rheumatic diseases. UpToDate. https://www.uptodate.com/contents/overview-of-biologic-agents-in-the-rheumatic-diseases
Monoclonal antibodies and their side effects. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy/monoclonal-antibodies.html
deShazo R, Kemp S. Pharmacotherapy of allergic rhinitis. UpToDate. https://www.uptodate.com/contents/pharmacotherapy-of-allergic-rhinitis
One beautiful young woman using neti pot. iStock by Getty Images. https://www.istockphoto.com/photo/one-beautiful-young-woman-using-neti-pot-gm1249770911-364309584
Mayo Clinic. Corticosteroid (Nasal Route). https://www.mayoclinic.org/drugs-supplements/corticosteroid-nasal-route/proper-use/drg-20070513
Optinose exhalation delivery system (EDS). https://xhancehcp.com/exhalation-delivery-system
Kim SD, Cho KS. Treatment strategy of uncontrolled chronic rhinosinusitis with nasal polyps: a review of recent evidence. Int J Mol Sci. 2023;24:5015.
Han JK, Bosso JV, Cho SH, et al. Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2021;11:1407-1416.
Han JK, Bachert C, Fokkens W, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med. 2021;9:1141-1153.
Gevaert P, Calus L, Van Zele T, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol. 2013;131:110-116.e1.