A new stepped-care treatment algorithm in the International Forum of Allergy & Rhinology, “Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps,” recommends Exhalation Delivery System-fluticasone (EDS-FLU) for the treatment of patients with nasal polyps, according to ENT pharmaceutical company Optinose.

It also recommends EDS-FLU as a step in between initial care with standard intranasal steroids and before escalation of care with surgery or biologic medicines.

The algorithm was informed by evidence-based, peer-reviewed data supporting the use of therapeutic and interventional treatments to arrive at the recommended stepwise care paradigm. The growing number of medical and surgical treatment options available for patients with nasal polyps can cause confusion among providers regarding the optimal sequence for those treatment modalities. The algorithm seeks to lend order to treatment and serve as a basis for improving quality of care. The publication discusses considerations in a pathway for care that incorporates several new treatments approved in recent years into a logical stepwise escalation of medical care, including but not limited to standard nasal steroid sprays, EDS-FLU, surgery, implants and biologics.

“Over 85% of patients suffering from chronic rhinosinusitis with nasal polyps are frustrated with the lack of symptom relief they get with standard nasal steroids,”said Ramy Mahmoud, MD, MPH, President of Optinose. “This is unsurprising since inflammation high and deep in the nasal cavity lies at the root of the disease and can be difficult to reach with standard nasal steroid sprays that patients typically try first.”2,3

XHANCE was approved by the FDA in 2017 for the treatment of nasal polyps in patients 18 years of age and older and is the only medication available that uses the EDS to deliver an anti-inflammatory medicine high and deep to the source of the problem. 

“Our goal is to share an emerging logical stepped-care guidance similar to what is used in other disease areas such as asthma in which treatment is escalated stepwise in attempt to achieve a full response,” said Dr. Joseph Han, Chief for the Division of Rhinology – Endoscopic Sinus and Skull Base Surgery and Chief for the Division of Allergy at Eastern Virginia Medical School and first author of the consensus paper. “Stepped-care guidelines in medicine can serve as a basis for reducing confusion and improving quality of care. We hope that physicians, as well as payers, will find this new approach useful in guiding individual patient-based decision making.”