Indication for biologic treatment in a real-world cohort of chronic rhinosinusitis patients according to international recommendations: Evidence from the European CRS outcome registry (CHRINOSOR)

Background: In recent years, treatment options for patients with uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) have been expanded with biologics. Definitions of uncontrolled severe disease differ across international recommendations and the prescription of biologics depends on national reimbursement criteria. Objective: We aimed to evaluate the indication for biologic treatment, based on international recommendations, in a real-world cohort of CRSwNP patients. Methods: CRS patients who visited the outpatient ENT clinic of 10 tertiary centres from 7 European countries were invited to use the Galenus Health mobile application monitoring their disease. The proportion of patients who fulfilled biologic indication criteria according to EUFOREA 2021 and EPOS/EUFOREA 2023 recommendations was evaluated. Results: A total of 281 CRS patients were recruited of which 227 (82.1%) were diagnosed as CRSwNP. Out of these 227 patients, 21 patients with prior biologic use were excluded, resulting in a cohort of 206 patients. A total of 28.7% (50/174) and 47.6% (81/170) of CRSwNP patients, met the EUFOREA 2021 or EPOS/EUFOREA 2023 criteria for indication for biologic treatment, respectively. Biologic treatment was initiated at the time of inclusion in the cohort in 18.9% (39/ 206) of CRSwNP patients. Conclusion: According to international recommendations, 29-48% of CRSwNP patients in tertiary centres may be a candidate for biologic treatment. EPOS/EUFOREA2023 criteria were more inclusive than EUFOREA 2021 criteria with respect to biologic indication for CRSwNP. National reimbursement criteria prevail over international recommendations for actual biologic prescription and are less restrictive in some countries.