Boiko N V, Lodochkina O E, Kit M M, Kuleshova V G, Nedashkovskaya N G
Rostov state medical university, Rostov-on-Don, Russia.
Regional consultative and diagnostic center, Rostov-on-Don, Russia.
Vestn Otorinolaringol. 2021;86(2):43-48. doi: 10.17116/otorino20218602143.
Chronic rhinosinusitis (CRS) with polyps is associated with eosinophilic inflammation, in which the key mediator is interleukin - 5 (IL-5) and is often combined with asthma.
To evaluate the therapeutic potential of reslizumab-humanized anti-IL-5 monoclonal antibody for the treatment of CRS with polyps in patients with severe asthma.
We investigated the cases of 9 patients with severe asthma treated with intravenous reslizumab at a dose of 3 mg per 1 kg of weight with regularity once in 4 weeks. The presence of CRS with polyps was revealed in 7 of 9 patients, SCT scanning of the paranasal sinuses indicated changes in all the patients, 2 patients had symptoms of chronic non-allergic rhinitis (NARES).The treatment effectiveness control was carried out after 6 months from the beginning of the treatment by the dynamics of nasal symptoms (SNOT-22), endoscopic image of the nose, total polyp score (TPS), changes in the SCT of the paranasal sinuses on the Lund-Mackay scale, rhinocytogram, the content of eosinophilic cationic protein in the blood, the level of systemic eosinophilia. The effectiveness of asthma control was assessed by the reduction of the frequency of asthma exacerbations, the need for systemic corticosteroids, spirometry data and Asthma Control Test (ACT) results. Along with a marked improvement in asthma control, 8 out of 9 patients displayed clinical, endoscopic, radiological signs of weakening of nasal symptoms. More significant improvement in asthma control was achieved in patients having CRS with polyps. In the group of patients having CRS with polyps, it was possible to detect anamnestic presence of NARES symptoms in the early stages of the disease. This indicates that NARES can be a precursor to the development of eosinophilic, non-IgE-induced asthma and nasal polyps.
Treatment with reslizumab in patients with eosinophilic asthma and concomitant CRS with polyps and chronic non-allergic rhinitis (NARES) leads not only to improved control of asthma symptoms, but also to a significant regression of nasal symptoms.
伴息肉的慢性鼻-鼻窦炎（CRS）与嗜酸性粒细胞炎症相关，其中关键介质是白细胞介素-5（IL-5），且常合并哮喘。
评估瑞利珠单抗（一种人源化抗IL-5单克隆抗体）对重症哮喘患者伴息肉的CRS的治疗潜力。
我们调查了9例接受静脉注射瑞利珠单抗治疗的重症哮喘患者的病例，剂量为每千克体重3毫克，每4周规律给药一次。9例患者中有7例存在伴息肉的CRS，鼻窦计算机断层扫描（SCT）显示所有患者均有改变，2例患者有慢性非变应性鼻炎（NARES）症状。从治疗开始6个月后，通过鼻症状动态变化（SNOT-22）、鼻内镜图像、总息肉评分（TPS）、鼻窦SCT在Lund-Mackay量表上的变化、鼻细胞涂片、血液中嗜酸性粒细胞阳离子蛋白含量、全身嗜酸性粒细胞水平来进行治疗效果对照。通过哮喘发作频率的降低、全身用糖皮质激素的需求、肺功能测定数据和哮喘控制测试（ACT）结果来评估哮喘控制的有效性。除哮喘控制有显著改善外，9例患者中有8例表现出鼻症状减轻的临床、内镜、放射学体征。伴息肉的CRS患者在哮喘控制方面取得了更显著的改善。在伴息肉的CRS患者组中，有可能在疾病早期发现NARES症状的既往史。这表明NARES可能是嗜酸性粒细胞性、非IgE介导的哮喘和鼻息肉发生的先兆。
用瑞利珠单抗治疗嗜酸性粒细胞性哮喘并伴有息肉的CRS和慢性非变应性鼻炎（NARES）患者，不仅能改善哮喘症状的控制，还能使鼻症状显著消退。
