Practice parameterThe Joint Task Force on Practice ParametersCheck for updatesGRADE guidelines for the medical managementof chronic rhinosinusitis with nasal polyposisMatthew A.Rank,MD,b Derek K.Chu,MD,PhD,Antonio Bognanni,MD,PhD,Paul Oykhman,MD,MSc,Jonathan A.Bernstein,MD,d Anne K.Ellis,MD,MSc,FRCPC,David B.K.Golden,MDCM,Matthew Greenhawt,MD,MBA,MSc,9 Caroline C.Horner,MD,MSCI,Dennis K.Ledford,MD,jk Jay Lieberman,MD,mAmber U.Luong,MD,PhD,"Richard R.Orlandi,MD,Shefali A.Samant,MD,P Marcus S.Shaker,MD,MS,qZachary M.Soler,MD,MSc,Whitney W.Stevens,MD,PhD,David R.Stukus,MD,4 Julie Wang,MD,w andAnju T.Peters,MDtScottsdale and Phoenix,Ariz;Hamilton and Kingston,Ontario,Canada;Cincinnati and Columbus,Ohio:Baltimore,Md:Aurora.Colo:St Louis.Mo:Tampa.Fla:Memphis.Tenn:Houston.Tex:Salt Lake City.Utah:Los Angeles.Calif:Lebanon,NH:Charleston,SC;Chicago,Ill:and New York NYThese evidence-based guidelines support patients,cinicians,guideline panel reached consensus on the following statements:and other stakeholders in decisions about the use of intranasal(1)In people with CRSwNP,the guideline panel suggests INCScorticosteroids (INCS),biologics,and aspirin therapy afterrather than no INCS (conditional recommendation,lowdesensitization (ATAD)for the management of chroniccertainty of evidence).(2)In people with CRSwNP,the guidelinerhinosinusitis with nasal polyposis(CRSwNP).It is important topanel suggests biologics rather than no biologics(conditionalnote that the current evidence on surgery for CRSwNP was notrecommendation,moderate certainty of evidence).(3)In peopleassessed for this guideline nor were management options otherwith aspirin(nonsteroidal anti-inflammatory drug)-exacerbatedthan INCS,biologics,and ATAD.The Allergy-Immunologyrespiratory disease,the guideline panel suggests ATAD ratherJoint Task Force on Practice Parameters formed athan no ATAD (conditional recommendation,moderatemultidisciplinary guideline panel balanced to include the viewscertainty of evidence).The conditions for each recommendationof multiple stakeholders and to minimize potential biases.are discussed in the guideline.(J Allergy Clin ImmunolSystematic reviews for each management option informed the2023:151:386-98.)guideline.The guideline panel used the Grading ofRecommendations Assessment,Development and EvaluationKey words:Chronic rhinosinusitis,nasal polyposis,aspirin,corti-approach to inform and develop recommendations.Thecosteroids,biologics,clinical guidelineFromthe Mayo Clinic in Arizona,Scottsdale,Phoenix Children's Hospital;McMasterMerch,Roche,GSK,and Aimmune Therapeutics.M.Greenhawt reports serving on anUniversity,Hamilton University of Cincinnati:the Division of Allergy and Immu-advisory board for Allergy Therapeutics,Allergenis,Sanofi Regeneron,Pfizer,USnology,Department of Medicine,Queen's University,Kingston:Johns Hopkins Uni-World Meds,Prota Therapeutics,Aquestive,Novartis,Intrommune Therapeutics,versity School of Medicine,Baltimore:Children's Hospital Colorado and thea
