EPOS2020 from bench to bedside Management of patients, what is new Professor Wytske Fokkens Amsterdam University Medical Centres, location AMC
EP EPOS OS 2020: Management of patients, what is new • Integrated care pathways in ARS • New classification of CRS, primary versus secondary CRS: consequences for treatment • Evidence based treatment • New integrated care pathways in CRS Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
Antibiotics in patients with ABRS
Antibiotics in patients with postviral ARS NNT:17
Intranasal corticsteroids in postviral ARS
Antibiotics prescription and resistance
EP EPOS OS 2020: Management of patients, what is new • Integrated care pathways in ARS • New classification of CRS, primary versus secondary CRS: consequences for treatment • Evidence based treatment • New integrated care pathways in CRS Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
New Classification of CRS Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
New Classification of CRS Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
Montelukast in diffuse bilateral CRS
Regular or high dose of INCS in diffuse bilateral CRS Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
Difference in effect of INCS in CRS patients without or with surgery
Aspirin treatment after desensitisation (ATAD)
No effect of short term antibiotics after (F)ESS
Reverse Trendelenburg position reduces blood loss during (F)ESS
Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
Diffuse bilateral CRS management scheme Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. AMT, appropriate medical treatment; INCS, intranasal corticsteroids; web: www.epos2020.com, rhinologyjournal.com
Treatment of Type 2 Inflammation in Chronic Rhinosinusitis anti- IL-5 - mepolizumab - reslizumab. anti-IL-4/anti-IL-13 - dupilumab anti-IgE - omalizumab De Greve, Hellings, Fokkens et al Clin Trans. Allergy 2017
Dupilumab in CRSwNP Responder Analysis: Percent of Patients With NPS Improvement from Baseline Improvement by at least 1 point in NPS from baseline 0.5 Improvement by at least 2 points in NPS from baseline LS Mean Change from 80 0.0 Baseline (± SE) Placebo 66% -0.5 70 -1.0 54% Proportion of Patients (%) 60 -1.5 Dupilumab 300 mg -2.0 50 Q2W -2.5 40 0 4 8 12 16 20 24 28 32 36 40 44 48 52 Week 30 20 12% 0.5 LS Mean Change from Baseline 10 5% 0.0 Placebo 0 -0.5 Dupilumab 300 Placebo -1.0 (± SE) mg Q2W Dupilumab 300 mg Q2W– -1.5 Q4W SINUS-52 -2.0 -2.5 Week 52 Dupilumab 300 mg Q2W 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 Week All P -values <0.0001 NPS, nasal polyp score; Q2W, every 2 weeks. Bachert, Fokkens et al. Lancet 2019 Data on file.
Dupilumab in CRSwNP: Secondary Efficacy: LS Mean Change from Baseline in SNOT-22 Total Score 0 0 LS Mean Change from LS Mean Change from Baseline -5 -5 Baseline (± SE) Placebo -10 -10 SINUS-24 EOT -15 -9.31 -15 (± SE) -20 -20 Dupilumab 300 mg Q2W -25 -25 P <0.0001 LS mean -30 -30 difference for all points -35 -30.43 -35 from Week 4–EOT vs 0 4 8 12 16 20 24 28 32 36 40 44 48 52 Week 24 placebo. Baseline Baseline Week 50.87 (20.22) 48.00 (20.16) 0 0 LS Mean Change from Baseline (± -5 Placebo -5 LS Mean Change from Baseline (± -10 -10 SINUS-52 -15 -15 Switch -10.4 Dupilumab 300 mg Q2W–Q4W -20 -20 SE) -25 SE) -25 -30 Dupilumab 300 mg Q2W -30 -35 -27.77 -35 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 Week 24 Week Baseline Baseline 53.48 (21.85) 51.02 (20.37) Bachert, Fokkens et al. Lancet 2019 Placebo Dupilumab 300 mg Q2W
Dupilumab in CRSwNP: Secondary Efficacy: LS Mean Change from Baseline in Daily Assessed Loss of Smell 0.0 0.0 LS Mean Change from Baseline LS Mean Change from -0.2 -0.2 Placebo Baseline (± SE) -0.4 -0.4 -0.29 -0.6 SINUS-24 -0.6 EOT -0.8 -0.8 (± SE) Dupilumab 300 mg Q2W -1.0 -1.0 -1.2 -1.2 -1.4 -1.4 -1.41 -1.6 -1.6 P <0.0001 LS mean 0 4 8 12 16 20 24 28 32 36 40 44 48 52 Week 24 difference for all points Week from Week 4–EOT vs Baseline Baseline placebo. 2.73 (0.51) 2.70 (0.57) 0.0 0.0 -0.2 -0.2 Placebo LS Mean Change from Baseline (± LS Mean Change from Baseline (± -0.4 -0.4 -0.23 SINUS-52 -0.6 -0.6 Dupilumab 300 mg Q2W- Switch Q4W -0.8 -0.8 Dupilumab 300 mg Q2W -1.0 -1.0 SE) SE) -1.2 -1.2 -1.4 -1.4 -1.21 -1.6 -1.6 Week 24 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 Week Baseline Baseline 2.72 (0.52) 2.77 (0.53) Placebo Dupilumab 300 mg Q2W
EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy. 2019 Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
Diffuse bilateral CRS management scheme Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. AMT, appropriate medical treatment; INCS, intranasal corticsteroids; web: www.epos2020.com, rhinologyjournal.com
Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com
Thank you for listening www. rhinology.com www.epos2020.com
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