What Otolaryngologists Need to Know about Biologics and Allergic Rhinitis

The Cost of Biologics

Despite the promise of biologics, their high cost remains a significant hurdle, and one that otolaryngologists must consider as they decide whether to incorporate these drugs into the treatment of AR. “If we are going to prescribe something that is very expensive, we need to consider, how does it compare to other accepted therapies for allergic rhinitis,” Dr. Lin said. “New is great, but it’s not always cost-effective and may not have superior outcomes.”

Additional research is needed to help delineate which AR patients, under which circumstances, may most benefit from biologics. “We need to identify which subpopulation would benefit a lot in order to avoid a tremendous cost burden to the health system,” Dr. Chaaban added.

Research studies examining the cost-effectiveness of biologic treatment versus endoscopic sinus surgery for chronic rhinosinusitis, for instance, have found that surgery is a more cost-effective approach than treatment with dupilumab, regardless of the frequency of revision surgery (Laryngoscope. 2021;131:E26-E33). However, the $10,000 to $40,000 annual cost of biologic treatment may result in decreased annual health expenditures for patients with severe allergic asthma if such treatment decreases emergency room visits and intensive care admissions (Pediatr Investig. 2019;3:165- 172). It remains to be seen whether biologic treatment is a cost-effective approach to AR management.

The patent for omalizumab expired in 2018, and at least one omalizumab biosimilar has already demonstrated equivalent safety and efficacy in a phase 1 trial presented as a poster at this year’s American Academy of Allergy, Asthma, and Immunology’s annual meeting. The eventual availability of biosimilars may ease the cost burden of biologic treatment, increasing its utility in clinical practice.

Right now, it seems unlikely that biologics will be a first-line treatment for AR. Perhaps, as with chronic rhinosinusitis, biologic treatment primarily will be used to manage disease in patients who do not achieve satisfactory symptom relief with less expensive treatments. Early biologic treatment of AR symptoms may eventually help slow the atopic march and prevent the development of food allergies in some individuals. At present, otolaryngologists who have patients with difficult-to-control AR symptoms may want to dive more deeply into their patients’ dermatologic and pulmonary histories. Those who have a history of atopic dermatitis or asthma may benefit from biologic treatment.

Jennifer Fink is a freelance medical writer based in Wisconsin.