Monoclonal antibody selection in the treatment of chronic rhinosinusitis with nasal polyps

Genetically engineered biological therapy is a new promising treatment option for T2-induced chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, there are 4 monoclonal antibodies indicated for this disease (dupilumab, mepolizumab, omalizumab, tezepelumab), and their list will gradually expand. Criteria for prescribing these drugs and criteria for assessing their effectiveness have been developed. Nevertheless, there are no clear guidelines for choosing a monoclonal antibody in a specific clinical case. The objective of this review is to analyze factors that can significantly influence the choice of monoclonal antibody in the uncontrolled course of T2-induced CRSwNP. It has been shown that dupilumab genetically engineered biological drug (GEBD) is an agent of choice for the treatment of primary, uncomplicated, T2-induced CRSwNP with an uncontrolled course. In case of high blood eosinophil counts, careful diagnosis is necessary for the early detection of possible eosinophil-associated diseases; if there are indications for GEBT, mepolizumab may be the starting monoclonal antibody in such patients. Patients with concomitant allergic diseases are candidates for the prescription of omalizumab monoclonal antibody.