Biologic drugs are a form of immunotherapy, and they target different parts of the immune system to affect immune and inflammatory responses. Biologics, such as vaccines, can prevent disease. Biologics can also treat diseases, such as cancer, asthma, and now nasal polyps.
The biologics with approval for treating nasal polyps are all forms of monoclonal antibodies. They include:
- dupilumab (Dupixent)
- mepolizumab (Nucala)
- omalizumab (Xolair)
Here are some signs that it might be time to try biologics for your nasal polyps.
1. You have nasal polyps on both sides
Doctors call it bilateral when you have nasal polyps on both sides of the nose. Many guidelines for the use of biologics say that the first requirement is having bilateral nasal polyps.
Your doctor can see the bilateral nasal polyps by looking in the nose with a light, using an MRI scanner, or doing a nasal endoscopy, which involves inserting a thin tube with a lighted camera to look inside your nose and sinuses.
2. You are still having symptoms despite other treatments
All of the biologics that treat nasal polyps have approval as add-on or adjuvant treatments. If you are already taking another treatment and symptoms continue, a biologic may help. Doctors call this refractory disease.
Your doctor may recommend a biologic for refractory disease if you have:
- a high sinonasal outcome test score despite taking corticosteroids
- taken oral corticosteroids in the last year
- had surgery
3. Your symptoms are increasing
If your symptoms are not improving or you are getting new symptoms, it may be time for a biologic. Your doctor may recommend a biologic if you notice the following symptoms:
- congestion in the nose or sinuses
- loss of smell or taste
- nasal blockage
- postnasal drip
- runny nose
4. Your symptoms are affecting your quality of life
Experts can sum up quality of life as a disease’s effect on you physically, emotionally, and socially. Having nasal polyps can decrease your quality of life. This can result in effects such as:
- anxiety
- depression
- embarrassment
- frustration
- hopelessness
- phobias
- reduced concentration
- sadness
- sleep difficulties
5. You have another condition that could also benefit from a biologic
People with nasal polyps often also have other conditions that a biologic could treat. These are comorbidities. If you have any of the following comorbidities, a biologic might help your nasal polyps and the other condition:
- allergic fungal rhinosinusitis
- aspirin-exacerbated respiratory disease
- asthma
- atopic dermatitis
- chronic spontaneous urticaria
Talking with your doctor about biologics
As a condition, nasal polyps can vary from person to person. This has led doctors to a very personalized approach to treating them. There are general guidelines for treating nasal polyps. However, each person is different. So, it is important to work with your doctor as a team.
Some questions you may want to ask include:
- Am I a candidate for a biologic? Why or why not?
- How do biologics differ from other nasal polyp treatments?
- Can a biologic improve my quality of life?
- Can a biologic reduce the need for corticosteroids?
- Can a biologic help prevent surgery or the need for another surgery?
- What are the possible side effects and risks of taking a biologic?
The advice to start a biologic may vary with the type of doctor you contact. For example, an otolaryngologist may have a different recommendation than an allergist. Getting a second opinion from another doctor may give you another point of view and more information.