Positioning the Principles of Precision Medicine in Care Pathways for Allergic Rhinitis and Chronic Rhinosinusitis - an EUFOREA-ARIA-EPOS-AIRWAYS ICP statement.

Hellings PW1,2,3, Fokkens WJ2, Bachert C3,4, Akdis CA5, Bieber T6, Agache I7, Bernal-Sprekelsen M8, Canonica GW9, Gevaert P3, Joos G10, Lund V11, Muraro A12, Onerci M13, Zuberbier T14, Pugin B15, Seys SF15,16, Bousquet J17; ARIA and EPOS working groups.

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Abstract

Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document is to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its' implementation and the high cost of molecular diagnosis and biological treatment. This article is protected by copyright. All rights reserved.