Implementation of biologicals in Japanese CRSwNp Patients
In Europe and the United States, chronic rhinosinusitis is divided into two subgroups: chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). The majority of CRSwNP cases have a strong tendency to recur after surgery and show eosinophil-dominant inflammation. However, this definition has proved very difficult to apply in Japan and East Asia because more than half of the CRSwNP cases do not exhibit eosinophil-dominant inflammation. In Japan, the term ‘eosinophilic chronic rhinosinusitis’ was introduced to differentiate it from Non-ECRS. CRSwNP is often difficult to treat, but the advent of new treatments involving monoclonal antibodies (or biologics) looks like very good news for sufferers worldwide and now also in Japan.
In this episode, we invited Prof. Shigeharu Fujieda, Professor in the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Fukui in Japan, and Prof. Ruby Pawankar who is President of the Asia-Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), Head of Allergy Division, Department of Paediatrics, Nippon Medical School, Tokyo, Japan, former WAO (World Allergy Organization) President 2012-2013.
Prof. Shigeharu Fujieda helps us to understand the recent indication of Dupilumab (a biological) in CRSwNP in Japan, while Prof. Pawankar explains what exactly underlies severe uncontrolled CRSwNP in Japan and what profile of Japanese patients will benefit from the new biologicals for CRSwNP.
Last year, Japanese health insurance decided to cover Dupilumab for CRSwNP as it does for refractory severe asthma and refractory atopic dermatitis. The Japanese Ministry of Health has issued a guideline for the proper use of Dupilumab and are quite strict with restrictions. Prof Fujieda explains the Refractory Eosinophilic Rhinosinusitis score (JESREC) and how this JESREC scoring system helps patients and physicians. The aim of the JESREC study is to understand the characteristics of ECRS, establish diagnostic criteria, and classify ECRS. We developed an algorithm to classify the severity of ECRS. The algorithm consists of the percentage of eosinophil in peripheral blood, CT findings, and comorbidity. The algorithm was divided into four groups. Before performing endoscopic sinus surgery on patients with CRSwNP, doctors can predict the likelihood of postoperative recurrence and explain the length and duration of steroids to be prescribed after surgery through the use of the JESREC Scoring System.