New jab could end misery of a persistent runny nose

Long-lasting drugs could soon transform the lives of tens of thousands of Britons living with a debilitating condition that causes a permanently streaming nose and loss of smell.

Treatments known as biologics – which work by switching off the immune system reaction that drives inflammation – are on the cusp of wider use for patients with the most severe form of chronic rhinosinusitis.

Two drugs, depemokimab and tezepelumab, have been approved this month by the Medicines and Healthcare products Regulatory Authority (MHRA), meaning they can now be bought privately.

Another, dupilumab, is being appraised by the spending watchdog, National Institute for Health and Care Excellence (NICE), for use on the NHS, while tezepelumab will be assessed in January.

All have been shown to reduce nasal growths and relieve symptoms, while also cutting the need for steroid tablets and repeated surgery.

It comes at a time of year when sniffles are common, and the ‘super flu’ virus is putting pressure on the NHS. But for those with a runny nose that refuses to budge – lasting for weeks, months or even years – the problem is far more serious.

A streaming nose is one of the main symptoms of chronic rhinosinusitis, an inflammatory condition impacting the nose and sinuses, which affects around 11 per cent of adults in the UK For most, it is triggered by an infection that leads to lingering inflammation, and can be treated with steroid nasal sprays or tablets.

But for tens of thousands with the most serious form of the condition, the cause remains largely unknown.

 A long-term immune system reaction causes extreme inflammation in the nose, leading not only to constant dripping but to soft tissue growths known as nasal polyps.

These swellings can block the olfactory nerves that carry scent signals to the brain, causing partial or total loss of smell and taste.

Known as chronic rhinosinusitis with nasal polyps, or CRSwNP, the condition can have a devastating impact. Alongside loss of smell and taste, as well as a dripping nose, symptoms include facial pressure, sleep problems and post-nasal drip – where mucus runs down the back of the throat.

Experts and charities say the condition has long been overlooked, with few treatments available.

Patients are generally given steroid nasal sprays, antihistamines and steroid tablets to shrink the polyps, and are offered surgery to remove them if this does not work. For many, however, both the polyps and symptoms return.

Steroid tablets can provide relief, but long-term use is linked to weakened bones, weight gain and cardiovascular problems. 

Around 50 per cent of patients do not respond to steroids and require an operation, known as functional endoscopic sinus surgery, which involves opening the sinus cavity to remove the polyps and their roots. 

But the new biologic therapies target specific parts of the immune system involved in driving the inflammation and calm the response. All are given by injection – once every six months in the case of depemokimab, and once a month for the others.

Professor Rami Salib, a rhinologist at University Hospital Southampton, says there is growing evidence from trials and real-world use that the drugs can improve symptoms, restore smell and reduce the need for repeated surgery.

‘They could enable us to take patients off steroids,’ he says Duncan Boak, of the charity SmellTaste, says there is an urgent need for new treatments, particularly for those whose polyps keep returning.

‘People have multiple operations over the years to no avail and it has a huge impact on their quality of life,’ he adds.

For Lee Dovey, a 42-year-old IT engineer from Dudley, West Midlands, who has lived with CRSwNP for four years, the condition has been ‘horrendous’. Having refused surgery over fears it would not make a lasting impact, he says: ‘Any new treatments would be welcome.’