D1.119 - Care pathways and systemic steroid (over)use in chronic rhinosinusitis with nasal polyps (CRSwNP) in Germany

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the paranasal sinuses and nasal cavity causing nasal obstruction, hyposmia, loss of smell, facial pain and pressure, and reduced quality of life. Standard treatments include intranasal corticosteroids (INCS), intranasal rinses, systemic corticosteroids (SCS) and functional endoscopic sinus surgery (FESS); aspirin desensitization is an option in selected cases. For patients not controlled by standard therapy, national and international guidelines recommend add‑on biologics and OCS sparing because of transient benefits and severe adverse effects. This study used statutory health insurance (SHI) claims data to map care pathways and identify treatment gaps for CRSwNP in Germany.

Retrospective observational cohort study using SHI claims (2012–2021). Included were adults (≥18 years) with a confirmed NP diagnosis (ICD‑10 J33) and ≥48 months continuous SHI enrollment prior to diagnosis. Use of INCS, SCS, biologics and performed FESS after initial diagnosis was analyzed.

Out of ~6.8 million patients insured in the eligible study period, 17,374 incident CRSwNP patients (mean 53 yoa; 41% female) were identified (2012–2021), equivalent to ~39,000–57,000 new cases per year in Germany. Overall, 21.5% received high‑dose SCS a median of 93 days after diagnosis; among these, 88% had no subsequent surgery and 99% did not receive a biologic. 15.4 % underwent sinus surgery within 12 months (median 161 days). Of those who had SCS before surgery (N=537), 76.5% received SCS again within 12 months post‑surgery. Only 1.9% of surgically treated patients received biologics afterward.

Findings suggest diagnoses often occur late in the disease course, with rapid reliance on SCS and/or early surgery. Moreover, many patients required medical treatment with SCS despite surgery. Although biologics became available already in 2019, their implementation in clinical care as a therapy option for uncontrolled severe CRSwNP patients despite FESS within one year after surgery remained an exception. Care gaps should be addressed along the guideline recommendations advocating stepwise care with optimized topical therapy, structured follow‑up and timely biologic escalation to reduce OCS exposure and improve outcomes.