Introduction
The treatment for patients suffering from uncontrolled severe CRSwNP has been subject to a revolution of care given the growing insight into the underlying pathology over the past two decades, the recommendation to evaluate biomarkers in the context of biologics, and the increased awareness of comorbidities (1-3).
A better understanding of the underlying inflammatory pathways has led to biologics emerging as an effective novel treatment option. This option supplements the classic advanced treatment options after appropriate medical treatment with nasal corticosteroids and rinsing for CRSwNP, such as oral corticosteroids and endoscopic sinus surgery (4, 5).
EUFOREA is an international not-for-profit organization aiming to prevent and reduce the burden of chronic respiratory diseases via the implementation of optimal care. In the context of CRS, a simplified treatment algorithm was launched, with the aim to educate all healthcare providers dealing with CRS on the treatment options and referral patterns, and to shorten the disease journey for CRS (6). EPOS2020 is the 2020 version of the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps. The expert teams of both organizations closely work together to improve management of CRS. Besides baseline treatment with nasal rinses and intranasal corticosteroids, the following five key pillars of specialist care have been used for uncontrolled severe CRSwNP based on personal history and disease journey: oral corticosteroids, primary and revision sinus surgery, biologics and aspirin therapy after desensitization (ATAD).
For several years, biologics have been indicated and are available in a growing number of countries for severe uncontrolled CRSwNP with the need to define specific criteria for the indication. In that context, EUFOREA has defined criteria for the indications of biologics in 2019 (7, 8), which have been finetuned in 2023 (9). In contrast to biologics, no international consensus has been reached on the specific academic criteria for the indications of systemic corticosteroids, primary or revision sinus surgery, or ATAD. Here, the EUFOREA/EPOS2020 expert panel of CRS supplemented with experts of the European Rhinology Society (ERS) and American Rhinology Society (ARS) have joined forces to agree on criteria, outcomes, contra-indications and considerations in relation to the different treatment options for CRSwNP. The statements of the authors are based on extensive clinical experience and expertise and the current scientific knowledge in relation to each therapeutic option for CRSwNP.