University of Kansas School of Medicine, Kansas City, KS.
Department of Otorhinolaryngology, Mayo Clinic, Phoenix, AZ.
Int Forum Allergy Rhinol. 2021 Aug;11(8):1152-1161. doi: 10.1002/alr.22774. Epub 2021 Feb 1.
Asthma and some chronic rhinosinusitis (CRS) subtypes are mediated by similar pathophysiologic mechanisms. The purpose of this study was to evaluate the effects of biologic therapy for asthma on co-existent CRS in the "real-world" setting.
A review of electronic health records (2016-2019) at Mayo Clinic was conducted to identify asthma patients treated with biologics who had co-existent CRS. Matched-pair analyses compared pretherapy and posttherapy Lund-Mackay computed tomography (CT) scores and 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Performance of endoscopic sinus surgery (ESS) after initiating biologics was studied.
We identified 247 patients who received anti-asthma biologic therapy and had co-existent CRS. Of these, 181 patients (73.3%) had CRS with nasal polyposis (CRSwNP) and 66 (26.7%) had CRS without nasal polyposis (CRSsNP). The biologics utilized were omalizumab (51.0%), mepolizumab (46.6%), benralizumab (10.5%), reslizumab (1.6%), and dupilumab (2.4%). Anti-interleukin-5 (anti-IL-5) intervention was associated with significant improvement in CT scores (CRS overall, CRSwNP subgroup, CRSsNP subgroup) and SNOT-22 scores (CRS overall, CRSwNP subgroup). Patients on omalizumab had a decrease in CT scores, but not SNOT-22 scores. ESS was performed in 206 patients (84.1%); 55 (22.3%) underwent surgery post-biologic intervention (anti-IL-5: 16.5%; omalizumab 27.8% of patients).
Anti-IL-5 agents were associated with improved CT and SNOT-22 scores in the overall CRS group and in CRSwNP subgroup; CRSsNP patients showed improved CT scores only. Omalizumab improved CT but not SNOT-22 scores. ESS was performed in 22% of patients after initiating biologics. These real-world results may influence future trial designs and clinical applications of biologics for CRS. ©2021 ARSAAOA, LLC.
哮喘和一些慢性鼻-鼻窦炎（CRS）亚型由相似的病理生理机制介导。本研究的目的是评估生物疗法治疗哮喘对“真实世界”中同时存在的 CRS 的影响。
对梅奥诊所的电子健康记录（2016-2019 年）进行了回顾性分析，以确定接受生物制剂治疗的哮喘患者，这些患者同时患有 CRS。配对分析比较了治疗前和治疗后的 Lund-Mackay 计算机断层扫描（CT）评分和 22 项鼻-鼻窦结局测试（SNOT-22）评分。研究了开始使用生物制剂后进行内镜鼻窦手术（ESS）的情况。
我们确定了 247 名接受抗哮喘生物治疗且同时患有 CRS 的患者。其中，181 名患者（73.3%）患有伴有鼻息肉的 CRS（CRSwNP），66 名患者（26.7%）患有不伴鼻息肉的 CRS（CRSsNP）。使用的生物制剂为奥马珠单抗（51.0%）、美泊利单抗（46.6%）、贝那利珠单抗（10.5%）、瑞利珠单抗（1.6%）和度匹鲁单抗（2.4%）。抗白细胞介素-5（抗-IL-5）干预与 CT 评分（总体 CRS、CRSwNP 亚组、CRSsNP 亚组）和 SNOT-22 评分（总体 CRS、CRSwNP 亚组）的显著改善相关。奥马珠单抗组患者 CT 评分下降，但 SNOT-22 评分无变化。206 名患者接受了 ESS（84.1%）；55 名患者（22.3%）在生物治疗干预后进行了手术（抗-IL-5：16.5%；奥马珠单抗占患者的 27.8%）。
抗 IL-5 药物与总体 CRS 组和 CRSwNP 亚组的 CT 和 SNOT-22 评分改善相关；CRSsNP 患者仅 CT 评分改善。奥马珠单抗改善 CT 评分但不改善 SNOT-22 评分。开始使用生物制剂后，22%的患者接受了 ESS。这些真实世界的结果可能会影响未来 CRS 生物制剂试验设计和临床应用。
