EPOS2020 from bench to bedside Management of patients, what is new - - PowerPoint PPT Presentation

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. web: www.epos2020.com, rhinologyjournal.com

AMT, appropriate medical treatment; INCS, intranasal corticsteroids;

Treatment of Type 2 Inflammation in Chronic Rhinosinusitis

De Greve, Hellings, Fokkens et al Clin Trans. Allergy 2017

anti- IL-5

• mepolizumab
• reslizumab.

anti-IL-4/anti-IL-13

• dupilumab

anti-IgE

• omalizumab

Dupilumab in CRSwNP Responder Analysis: Percent of Patients With NPS Improvement from Baseline

Placebo Dupilumab 300 mg Q2W

Improvement by at least 1 point in NPS from baseline Improvement by at least 2 points in NPS from baseline

12% 66% 5% 54%

10 20 30 40 50 60 70 80

SINUS-52 Week 52

All P-values <0.0001

Proportion of Patients (%)

NPS, nasal polyp score; Q2W, every 2 weeks. Data on file.

• 2.5
• 2.0
• 1.5
• 1.0
• 0.5

0.0 0.5 4 8 12 16 20 24 28 32 36 40 44 48 52 56 LS Mean Change from Baseline (± SE) Week Placebo Dupilumab 300 mg Q2W– Q4W Dupilumab 300 mg Q2W

• 2.5
• 2.0
• 1.5
• 1.0
• 0.5

0.0 0.5 4 8 12 16 20 24 28 32 36 40 44 48 52 LS Mean Change from Baseline (± SE) Week Placebo Dupilumab 300 mg Q2W

Bachert, Fokkens et al. Lancet 2019

• 35
• 30
• 25
• 20
• 15
• 10
• 5

4 8 12 16 20 24 28 32 36 40 44 48 52 56 LS Mean Change from Baseline (± SE) Week

Placebo Dupilumab 300 mg Q2W–Q4W Dupilumab 300 mg Q2W

• 35
• 30
• 25
• 20
• 15
• 10
• 5

4 8 12 16 20 24 28 32 36 40 44 48 52 LS Mean Change from Baseline (± SE) Week

Placebo Dupilumab 300 mg Q2W

Dupilumab in CRSwNP:

Secondary Efficacy: LS Mean Change from Baseline in SNOT-22 Total Score

• 9.31
• 30.43
• 35
• 30
• 25
• 20
• 15
• 10
• 5

Week 24 LS Mean Change from Baseline (± SE)

• 10.4
• 27.77
• 35
• 30
• 25
• 20
• 15
• 10
• 5

Week 24 LS Mean Change from Baseline (± SE)

Baseline 50.87 (20.22) Baseline 48.00 (20.16) Baseline 53.48 (21.85) Baseline 51.02 (20.37)

Placebo Dupilumab 300 mg Q2W

SINUS-24 SINUS-52

Switch

P<0.0001 LS mean difference for all points from Week 4–EOT vs placebo.

EOT

Bachert, Fokkens et al. Lancet 2019

• 1.6
• 1.4
• 1.2
• 1.0
• 0.8
• 0.6
• 0.4
• 0.2

0.0 4 8 12 16 20 24 28 32 36 40 44 48 52 LS Mean Change from Baseline (± SE) Week

Placebo Dupilumab 300 mg Q2W

• 1.6
• 1.4
• 1.2
• 1.0
• 0.8
• 0.6
• 0.4
• 0.2

0.0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 LS Mean Change from Baseline (± SE) Week

Placebo Dupilumab 300 mg Q2W- Q4W Dupilumab 300 mg Q2W

Dupilumab in CRSwNP:

Secondary Efficacy: LS Mean Change from Baseline in Daily Assessed Loss of Smell

Switch

• 0.29
• 1.41
• 1.6
• 1.4
• 1.2
• 1.0
• 0.8
• 0.6
• 0.4
• 0.2

0.0 Week 24 LS Mean Change from Baseline (± SE)

• 0.23
• 1.21
• 1.6
• 1.4
• 1.2
• 1.0
• 0.8
• 0.6
• 0.4
• 0.2

0.0 Week 24 LS Mean Change from Baseline (± SE)

Baseline 2.73 (0.51) Baseline 2.70 (0.57) Baseline 2.72 (0.52) Baseline 2.77 (0.53)

Placebo Dupilumab 300 mg Q2W

SINUS-24 SINUS-52

P<0.0001 LS mean difference for all points from Week 4–EOT vs placebo.

EOT

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. web: www.epos2020.com, rhinologyjournal.com

AMT, appropriate medical treatment; INCS, intranasal corticsteroids;

Fokkens W, Lund V, Mullol J, et al. Rhinology 2020, vol 58 (Suppl 29): 1-464. web: www.epos2020.com, rhinologyjournal.com

• www. rhinology.com

www.epos2020.com

Thank you for listening