Biologics for Nasal Polyps: Common Barriers and Solutions

Nasal polyps are noncancerous growths that occur inside the nasal passageways. They are typically the result of chronic inflammation due to conditions such as rhinosinusitis, a common ailment that affects approximately 12% of adults worldwide.

Although they are not malignant, nasal polyps can exacerbate the already debilitating symptoms of rhinosinusitis, increasing congestion and contributing to facial pressure and pain as well as a loss of smell.

Traditional treatment of nasal polyps focuses on decreasing the chronic inflammation that is causing the growths as well as surgical removal of the polyps themselves and the management of symptoms.

Steroid nasal sprays are commonly used. Unfortunately, this is not effective for all individuals who suffer from nasal polyps and they end up undergoing repeated sinus surgeries to remove the growths. For this subset of patients, biologics may be a good option.

What Are Biologics for Nasal Polyps?

Biologic response modifiers are a class of medications that treat conditions such as nasal polyps by targeting specific components of an individual's immune system. Put another way they can modify the chemical responses of the immune system that are causing the inflammation thought to be responsible for the growth of nasal polyps.

Biologics are called such because they are made from living cells. Unlike many other pharmaceutical drugs, they are not synthesized chemically or from plants. They also don't typically come in the form of a tablet but as a solution that has to be injected.

Biologics can be antibodies, enzymes, hormones, or other types of biologic components or cells (even viruses). Vaccines and insulin are types of biologics that have been available for many years. In recent times this technology and class of medications have been rapidly expanding.

Besides nasal polyps biologics have been approved for the treatment of other inflammatory conditions including eczema and asthma. Dupixent (dupilumab) is a biologic approved for the treatment of nasal polyps in the United States. Several other biologics are currently being studied for this use but are not yet approved.

Barriers to Use

We will outline some of the common barriers people encounter when opting for the use of biologics for the treatment of their nasal polyps. In the following section, we will discuss possible solutions to these barriers.

Cost

Biologics are some of the most expensive medications on the market and cost is often a barrier to their use. It is not at all uncommon for these types of medications to cost in the tens of thousands for a year's worth of treatment if not more (some can cost hundreds of thousands per year).

This is partly due to a lack of competition in the market. Biosimilars are like the generic version of brand name biologics. They are intended to decrease the cost of these medications. Unfortunately, since biologics have proven more difficult to duplicate than other pharmaceuticals, biosimilars are only slightly less expensive than their brand name counterparts.

Biosimilars also tend to be what their name implies; only similar to the brand name drug but not exactly the same, meaning that some patients may not get the same benefit from a biosimilar that they would from the more expensive brand name version.

Furthermore, individuals with health insurance may encounter hurdles to get their companies to cover the cost of biologics. Many insurance companies will require that all other less expensive treatment options have been thoroughly exhausted before agreeing to cover the expense of biologics.

Uncomfortable Injections

As previously mentioned using a biologic drug such as Dupixent is not as easy as simply swallowing a pill. You will either need to learn to give yourself a shot, have a member of your family give you the injection, or have your healthcare provider give you the injection.

Proper disposal of the syringes may require you to take them to a pharmacy or other location (they should not be thrown in a regular garbage can). Some people may also find the discomfort of frequent injections to be a barrier to using this medication.

Side Effects

As with all medications, biologics used for the treatment of nasal polyps may have side effects that inhibit their use by certain individuals. Since Dupixent is currently the only biologic medication in the United States approved for the treatment of nasal polyps, the side effects mentioned in this section refer specifically to that medication.

As with almost all medications, it is possible to have a life-threatening allergic reaction to Dupixent called anaphylaxis. Signs of this type of reaction may include swelling of the face and lips, difficulty swallowing, difficulty breathing, and wheezing.

This side effect requires emergency medical attention and any individual who has had this type of reaction to dupilumab or any of the ingredients in this medication is no longer a candidate for its use.

Common side effects of Dupixent include injection site reactions, eye inflammation, increased white blood cell counts, sore throat, stomach problems, cold sores, joint pain, insomnia, and toothaches.

A rare but serious side effect can occur in people who take Dupixent and also have asthma, where the blood vessels become inflamed leading to subsequent symptoms such as a rash, fever, chest pain, difficulty breathing, or numbness and tingling.

Contraindications

Dupixent cannot be taken by everyone. Many of these contraindications may also apply to biologics that could be approved in the near future for treating nasal polyps. Dupixent (dupilumab) is contraindicated for use in individuals who are:

• Allergic to Dupixent (dupilumab) or any of the ingredients in this medication
• Under the age of 6 years old (it is untested in individuals under the age of 6 for any use, it is approved only in individuals over the age of 18 for the treatment of nasal polyps)
• Pregnant or wish to become pregnant (it is unknown if Dupilumab will harm your unborn baby and therefore should only be used with extreme caution)
• Breastfeeding (it is currently unknown if Dupilumab can harm a breastfeeding infant)
• Suffering from a parasitic (helminth) infection

Solutions

Cost

You may be surprised that many drug companies including the manufacturer of Dupixent offer assistance to some people wanting to purchase their drug. You can typically find this information on the manufacturer's website under cost and pricing information.

If you have health insurance you may receive pushback from the company when you are prescribed a biologic. Work with your healthcare provider to provide any necessary documentation to your insurance company and don't give up. Even with the extra red tape many companies ultimately cover the medications.

You may also ask your practitioner if a biosimilar drug is available that you can use instead, but don't be surprised if the answer is no. Keep checking back, however, with new biosimilar drugs likely to come onto the market.

Uncomfortable Injections

The discomfort of the injections may decrease over time. Meanwhile\, injection site reactions (pain, redness, swelling) are easily treated using cold or hot pads and over-the-counter pain relievers such as acetaminophen. Serious reactions at the injection site should be reported to your healthcare provider.

Side Effects

Common side effects such as stomach aches or sore throat may disappear over time on their own. Serious side effects should be reported to your healthcare provider, however, and some side effects may make it necessary to discontinue the medication.

Contraindications

Many contraindications cannot be worked around but some, like parasitic infections, may be treated and you may be able to safely use the drug once the infection has been adequately addressed.