The Joint Task Force on Practice Parameters GRADE guidelines for the medical management of chronic rhinosinusitis with nasal polyposis - 03/02/23

Doi : 10.1016/j.jaci.2022.10.026

Matthew A. Rank, MD ^a,^b, Derek K. Chu, MD, PhD ^c, Antonio Bognanni, MD, PhD ^c, Paul Oykhman, MD, MSc ^c, Jonathan A. Bernstein, MD ^d, Anne K. Ellis, MD, MSc, FRCPC ^e, David B.K. Golden, MDCM ^f,^⁎ , Matthew Greenhawt, MD, MBA, MSc ^g,^h, Caroline C. Horner, MD, MSCI ⁱ, Dennis K. Ledford, MD ^j,^k, Jay Lieberman, MD ^l,^m, Amber U. Luong, MD, PhD ⁿ, Richard R. Orlandi, MD ^o, Shefali A. Samant, MD ^p, Marcus S. Shaker, MD, MS ^q,^r,^⁎ , Zachary M. Soler, MD, MSc ^s, Whitney W. Stevens, MD, PhD ^t, David R. Stukus, MD ^u,^v, Julie Wang, MD ^w, Anju T. Peters, MD ^t
^a Mayo Clinic in Arizona, Scottsdale, Ariz
^b Phoenix Children’s Hospital, Scottsdale and Phoenix, Ariz
^c McMaster University, Hamilton, Ontario, Canada
^d University of Cincinnati, Cincinnati and Columbus, Ohio
^e Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
^f Johns Hopkins University School of Medicine, Baltimore, Md
^g Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
^h University of Colorado School of Medicine, Aurora, Colo
ⁱ Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
^j Morsani College of Medicine, University of South Florida and James A. Haley Veterans’ Affairs Hospital, Tampa, Fla
^k James A. Haley Veterans’ Affairs Hospital, Tampa, Fla
^l University of Tennessee Health Science Center and LeBonheur Children’s Hospital, Memphis, Tenn
^m LeBonheur Children’s Hospital, Memphis, Tenn
ⁿ McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Tex
^o University of Utah, Salt Lake City, Utah
^p Kaiser Permanente Southern California, Los Angeles, Calif
^q Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, NH
^r Section of Allergy, Dartmouth Hitchcock Medical Center, Lebanon, NH
^s Medical University of South Carolina, Charleston, SC
^t Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
^u Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio
^v Ohio State University College of Medicine, Columbus, Ohio
^w Icahn School of Medicine at Mount Sinai, New York, NY

^∗Corresponding author: David B.K. Golden, MDCM, or Marcus S. Shaker, MD, MS, Joint Task Force on Allergy-Immunology Practice Parameters, 555 E Wells Street, Suite 1100, Milwaukee, WI 53212.Joint Task Force on Allergy-Immunology Practice Parameters555 E Wells StreetSuite 1100MilwaukeeWI53212

Abstract

These evidence-based guidelines support patients, clinicians, and other stakeholders in decisions about the use of intranasal corticosteroids (INCS), biologics, and aspirin therapy after desensitization (ATAD) for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP). It is important to note that the current evidence on surgery for CRSwNP was not assessed for this guideline nor were management options other than INCS, biologics, and ATAD. The Allergy-Immunology Joint Task Force on Practice Parameters formed a multidisciplinary guideline panel balanced to include the views of multiple stakeholders and to minimize potential biases. Systematic reviews for each management option informed the guideline. The guideline panel used the Grading of Recommendations Assessment, Development and Evaluation approach to inform and develop recommendations. The guideline panel reached consensus on the following statements: (1) In people with CRSwNP, the guideline panel suggests INCS rather than no INCS (conditional recommendation, low certainty of evidence). (2) In people with CRSwNP, the guideline panel suggests biologics rather than no biologics (conditional recommendation, moderate certainty of evidence). (3) In people with aspirin (nonsteroidal anti-inflammatory drug)-exacerbated respiratory disease, the guideline panel suggests ATAD rather than no ATAD (conditional recommendation, moderate certainty of evidence). The conditions for each recommendation are discussed in the guideline.

Le texte complet de cet article est disponible en PDF.

Key words : Chronic rhinosinusitis, nasal polyposis, aspirin, corticosteroids, biologics, clinical guideline

Abbreviations used : AAAAI, ACAAI, AERD, ATAD, CI, CRSwNP, EGPA, EPOS, EtD, GI, GIN, GRADE, ICAR-RS, INCS, JTF-PP, MD, MID, NMA, OR, RCT, SNOT, UPSIT

Plan

Executive summary of recommendations

Interpretation of strong and conditional recommendations

Values and preferences

Explanations and other considerations

Introduction to the guidelines

Aim of these guidelines and their specific objectives

Description of the health problem

Description of the target population

Description of the interventions

Description of the outcomes

Methods

Organization, panel composition, planning, and coordination

Guideline funding and the management of competing interests

Selection of questions and outcomes of interest

Evidence review and development of recommendations

Interpretation of strong and conditional recommendations

Document review

How to use these guidelines

Translation and quoting

Results

Question 1: Should INCS (topical corticosteroid), rather than no INCS, be used in CRSwNP?

Question 2: Should biologics, rather than no biologics, be used in CRSwNP?

Question 3: Should ATAD, rather than no ATAD, be used in people with AERD?

Discussion

Strengths and limitations of these guidelines

What others are saying and what is new in these JTF-PP guidelines

Revision or adaptation of these guidelines

Disclosure of potential conflict of interest: J.A. Bernstein reports consulting and/or speaking for Mylan, ALK-Abelló, Pharvaris, Celldex Therapeutics, Ionis, Amgen, Blueprint Medicine, BioMarin Pharmaceutical, GSK, OptiNose, CSL Behring, KalVista Pharmaceuticals, Merck, GI, Allakos, Teva Pharmaceuticals, Akarin, Sanofi Regeneron, AstraZeneca, Novartis, Genentech, Pharming, BioCryst Pharmaceuticals, and Shire/Takeda. A.K. Ellis reports consulting for GSK; speaking for Bausch Health, ALK-Abelló, AstraZeneca, GSK, Pfizer, Medexus Pharmaceuticals, and CSL Behring; and serving on advisory board for AbbVie, ALK-Abelló, and Novartis. D.B.K. Golden reports consulting with ALK-Abelló, Thermo Fisher Scientific, LabCorp, Allergy Therapeutics, and Novartis; speaking for Genentech; serving on an advisory board for Aquestive Therapeutics; and clinical trials support from Regeneron, Pfizer, Merch, Roche, GSK, and Aimmune Therapeutics. M. Greenhawt reports serving on an advisory board for Allergy Therapeutics, Allergenis, Sanofi Regeneron, Pfizer, US World Meds, Prota Therapeutics, Aquestive, Novartis, Intrommune Therapeutics, and DBV Technologies. D.K. Ledford reports consulting with AstraZeneca/Amgen, GSK, and BioCryst; speaking for Sanofi Regeneron, Genentech, Abbot, AstraZeneca/Amgen, and GSK; and serving on an advisory board for AstraZeneca/Amgen. J. Lieberman reports speaking for Genentech and serving on advisory boards for ALK-Abelló, DBV, and Novartis. M. Shaker participated in research funded by DBV. W.W. Stevens reports serving on an advisory board for GSK. D.R. Stukus reports consulting with Before Brands, Integrity CE, Kaléo, and Novartis. A.U. Luong reports consulting with Stryker, Medtronic, Sanofi, and Lyra Therapeutics, and serving on advisory boards for AstraZeneca, ENTvantage Diagnostics, and GSK. Z.M. Soler reports on consulting for OptiNose, Lyra, and GSK. J. Wang reports consulting for ALK-Abelló, Jubilant HollisterStier, Food Allergy Research and Education, and Genentech. A.T. Peters reports consulting with OptiNose and Sanofi Regeneron, and serving on advisory boards for GSK and AstraZeneca. The rest of the authors declare that they have no relevant conflicts of interest.