Abstract：
We aimed to reach an Italian multidisciplinary consensus on some crucial aspects of treatment decision making in CRSwNP, following 2 years of clinical experience in order to support specialists in the management of CRSwNP in clinical practice. We addressed issues relating to therapeutic decision-making and shared criteria for the treatment choice, as well as appropriate timing and criteria for evaluating treatment response, and highlighted the need for repeated multidisciplinary assessments.
A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.
A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.
摘要：
目的：我们旨在就CRSwNP治疗决策的一些关键方面达成意大利多学科共识，在2年的临床经验，以支持专家在临床实践中管理CRSwNP。我们解决了与治疗决策和治疗选择的共同标准有关的问题，以及评估治疗反应的适当时机和标准，并强调需要反复进行多学科评估。
结果：最近进行了一项全国性调查，以了解随着生物制剂的出现，意大利的鼻学实践发生了怎样的变化，以及这如何影响不受控制的患者，严重的CRSwNP。尽管发表了许多共识文件，实用建议,以及在CRSwNP中使用生物制剂的协议，实践中的异质行为仍然主要受到话题新颖性的制约。共识程序遵循修改后的Delphi方法。科学委员会包括18名耳鼻喉科医师和8名过敏症医师，他选择了要解决的4个主要主题，并总共制定了20个声明。更多的48名专家寻求就这些声明达成共识，通过两轮投票，第一个基于网络的，第二个在讨论和可能的完善的声明。在第二轮投票中达到平均得分≥7的声明获得批准。针对以下每个主题提出了五个陈述：符合生物治疗条件的患者的基线评估；不同治疗方案之间的选择；评估对生物治疗的反应；多学科管理。在第一轮投票中，20个陈述中有19个达到平均得分≥7。经过讨论和随后的一些修正，在第二轮投票中，所有20项声明均获得批准。
结果：最近进行了一项全国性调查，以了解随着生物制剂的出现，意大利的鼻学实践发生了怎样的变化，以及这如何影响不受控制的患者，严重的CRSwNP。尽管发表了许多共识文件，实用建议,以及在CRSwNP中使用生物制剂的协议，实践中的异质行为仍然主要受到话题新颖性的制约。共识程序遵循修改后的Delphi方法。科学委员会包括18名耳鼻喉科医师和8名过敏症医师，他选择了要解决的4个主要主题，并总共制定了20个声明。更多的48名专家寻求就这些声明达成共识，通过两轮投票，第一个基于网络的，第二个在讨论和可能的完善的声明。在第二轮投票中达到平均得分≥7的声明获得批准。针对以下每个主题提出了五个陈述：符合生物治疗条件的患者的基线评估；不同治疗方案之间的选择；评估对生物治疗的反应；多学科管理。在第一轮投票中，20个陈述中有19个达到平均得分≥7。经过讨论和随后的一些修正，在第二轮投票中，所有20项声明均获得批准。
