AAAAI & ACAAI GUIDELINES Bundle (free trial)

Treatment ➤ In people with CRSwNP, the Joint Task Force on Practice Parameters (JTFPP) suggests INCS rather than no INCS. (C-L) Additional considerations: ▶ The network meta-analysis linked to this guideline showed that delivery method of INCS was potentially important. INCS stent, spray, and EDS are among the most beneficial of the INCS delivery methods across multiple patient-important outcomes. ▶ The costs, availability, accessibility, and practical implications of the different methods of INCS delivery are likely to influence patient decision making. ▶ There is moderate certainty of evidence for the safety of INCS spray but safety may vary among the other delivery options. There is low or very low certainty in the safety of INCS using delivery methods other than spray. ▶ INCS have small treatment effect sizes. Patients with severe or rapidly recurrent disease may value more treatments with larger reductions in symptoms. ▶ There is probably uncertainty in the value and importance patients put on the outcomes that patients consider critical to decision making. ➤ In people with CRSwNP, JTFPP suggests biologics rather than no biologics. (C-M) Additional considerations: ▶ For patients who have a symptom for which the improvement was considered to be important while receiving treatments other than biologics (i.e., INCS, surgery, or aspirin therapy after desensitization [ATAD]), not using biologics may be preferred. ▶ For patients using INCS for at least 4 weeks and who continue to have high disease burden, or for patients who have higher disease severity at presentation, biologics may be preferred over other medical treatment choices. ▶ There is variability in efficacy among the biologics and this may influence the overall choice. See Table 2 for more information. ▶ Patients who value not having the burden of payment and insurance approvals may be less likely to choose biologics. Patients who want to avoid the inconvenience of trialing potentially less effective medical therapies may prefer biologics. ▶ In aspirin exacerbated respiratory disease (AERD) specifically, biologics may be preferred over ATAD for patients who have increased risk of harms associated with daily aspirin therapy, or in patients who value the most efficacious therapies and/or patients who wish to avoid a strict daily oral medication regimen and its associated initial desensitization procedure. ▶ Patients with comorbid diseases that lead to a dual indication for biologic treatment may be a reason to choose biologics in general and even specific biologics. ➤ In people with AERD, JTFPP suggests ATAD rather than no ATAD. (C-M) Additional considerations: ▶ Consider risks that impact the safety of performing an aspirin desensitization such as severe poorly controlled asthma. Consider risks that impact safety of long-term aspirin use such as conditions or treatments that increase bleeding risk. ▶ Biologics may be preferred over ATAD in AERD for patients who have increased risk of harms with ATAD or in patients who value the most efficacious therapies and/or avoiding a strict daily oral medication regimen and its associated desensitization procedure. ▶ Patients intolerant to NSAIDs and who require an NSAID for alternative indications may prefer ATAD over other options.

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