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慢性鼻窦炎伴鼻息肉的手术和/或生物制剂治疗:EUFOREA/EPOS共识文件。

Surgery and/or biologics in chronic rhinosinusitis with nasal polyps: EUFOREA/EPOS consensus paper.

指南共识鼻科IF 4.9Q1

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中文摘要

背景: 过去6年,随着生物制剂的问世,慢性鼻窦炎伴鼻息肉(CRSwNP)的治疗格局迅速演变,促使人们重新评估以糖皮质激素和鼻内镜手术(ESS)为核心的传统阶梯式管理。尽管ESS和生物制剂均已证实有效,但ESS相对于生物制剂的最佳顺序、范围和时机仍存争议。方法:EUFOREA/EPOS的国际多学科专家小组就ESS和生物制剂在CRSwNP中的目标、适应证、时机和治疗定位达成了共识。对关键随机对照试验、真实世界研究和近期指南的证据进行了批判性审查。共识声明经过多轮讨论和投票起草并完善。结果:本EUFOREA/EPOS报告提供了CRSwNP中ESS和生物制剂参与者的关键定义和临床标准,为个性化、循证医疗提供了统一框架,旨在为患者实现最佳结局。专家组一致认为,弥漫性病变患者至少应接受一次完整的ESS;根据当前证据,不建议同时启动鼻窦手术和生物制剂治疗;并强化了早期指南确立的生物制剂治疗适应证。结果强调,鉴于目前对全身性糖皮质激素副作用的了解,其长期使用不再被接受,尤其是在有生物制剂可用的情况下。结论:通过强调新型治疗策略的互补和疾病修饰作用,本倡议旨在按照EPOS/EUFOREA的使命,优化整个气道连续体的结局。

英文摘要

The therapeutic landscape of chronic rhinosinusitis with nasal polyps (CRSwNP) has rapidly evolved over the past 6 years with the arrival of biologics, prompting a re-evaluation of the traditional stepwise management centred on corticosteroids and endoscopic sinus surgery (ESS). Although both ESS and biologics have proven efficacy, the optimal sequence, extent and timing of ESS relative to biologics remains a matter of debate. The international multidisciplinary panel of experts of EUFOREA/EPOS reached consensus on the aims, indications, timing, and therapeutic positioning of ESS, and biologics in CRSwNP. Evidence from pivotal RCTs, real-life studies and recent guidelines was critically reviewed. Consensus statements were drafted and refined through multiple rounds of discussion and voting. This EUFOREA/EPOS report provides key definitions and clinical criteria for ESS and biologics particiin CRSwNP, offering a unified framework for personalized, evidence-based care with the aim to achieve the best outcomes for patients. The expert group agreed that patients with diffuse disease should have at least a primary complete ESS, that concurrent initiation of sinus surgery and biologic therapy is not recommended with current evidence, and the indication for biologic therapy as established by earlier guidelines were enforced. It was emphasized that with the current knowledge on side effects of systemic corticosteroids, their long-term use is no longer accepted especially where biologics are available. By emphasizing complementary and disease-modifying effects of novel care strategies, this initiative aims at optimizing outcomes across the entire airway continuum in line with EPOS/EUFOREA's mission.