Lyly Annina, Genberg Emma, Kauppi Paula, Virkkula Paula, Lee Stella E, Laidlaw Tanya M, Toppila-Salmi Sanna, Lundberg Marie
Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Inflammation Center, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Int Arch Allergy Immunol. 2023;184(2):149-160. doi: 10.1159/000526365. Epub 2022 Nov 7.
Biologics are used in the treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The purpose of this retrospective study was to evaluate the effects of biologics initiated for asthma on coexistent CRS and the influence of comorbid factors, including aspirin-exacerbated respiratory disease (AERD) and secretory otitis media (SOM).
A review of electronic health records (2009-2020) at a Finnish tertiary center was conducted to identify CRS patients treated with biologics for their asthma. We identified the type of biologic and treatment response, by comparing nasal polyp score (NPS), sinonasal outcome test (SNOT)-22, need for oral corticosteroids (OCS) and antibiotics, frequency of visits, and endoscopic sinus surgeries (ESS) pretreatment and during treatment.
55 patients were treated with anti-immunoglobulin E (IgE) (n = 18) or anti-interleukin-5/5-receptor (IL-5/5R) (n = 37) biologics. Treatment lasted for an average of 4.1 years. Seventy-five percent (n = 41) had CRSwNP and 25% (n = 14) had CRSsNP. Of all patients, 24% (n = 13) had comorbid AERD and 22% (n = 12) had SOM. Biologic therapy reduced the need for OCS courses (anti-IgE, n = 17, p = 0.03; anti-IL-5/5R, n = 35, p = 0.01) and for daily OCS in anti-IL-5/5R (n = 35, p = 0.001) but not in anti-IgE patients (n = 16, p = 0.07). Biologics also improved NPS by 0.5 point (n = 32, p = 0.009) and SNOT-22 by 14 points (n = 7, p = 0.02) in CRSwNP patients. The overall discontinuation rate was 37.7% (n = 20) and was independent of type of biologic.
Treatment with anti-IgE and/or anti-IL-5/5R biologics reduced the overall need for OCS medication in individuals with asthma and concomitant CRS, but despite this, the discontinuation rate was high.
生物制剂用于治疗重度哮喘和伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）。这项回顾性研究的目的是评估用于哮喘的生物制剂对共存的CRS的影响以及合并因素的影响，包括阿司匹林加重的呼吸系统疾病（AERD）和分泌性中耳炎（SOM）。
对芬兰一家三级中心的电子健康记录（2009 - 2020年）进行回顾，以确定因哮喘接受生物制剂治疗的CRS患者。通过比较鼻息肉评分（NPS）、鼻窦结局测试（SNOT）-22、口服糖皮质激素（OCS）和抗生素的使用需求、就诊频率以及内镜鼻窦手术（ESS）治疗前和治疗期间的情况，我们确定了生物制剂的类型和治疗反应。
55例患者接受了抗免疫球蛋白E（IgE）（n = 18）或抗白细胞介素-5/5受体（IL-5/5R）（n = 37）生物制剂治疗。治疗平均持续4.1年。75%（n = 41）患有CRSwNP，25%（n = 14）患有CRSsNP。在所有患者中，24%（n = 13）合并AERD，22%（n = 12）合并SOM。生物制剂治疗减少了OCS疗程的需求（抗IgE，n = 17，p = 0.03；抗IL-5/5R，n = 35，p = 0.01）以及抗IL-5/5R患者每日OCS的使用需求（n = 35，p = 0.001），但抗IgE患者中未减少（n = 16，p = 0.07）。生物制剂还使CRSwNP患者的NPS改善了0.5分（n = 32，p = 0.009），SNOT-22改善了14分（n = 7，p = 0.02）。总体停药率为37.7%（n = 20），且与生物制剂类型无关。
抗IgE和/或抗IL-5/5R生物制剂治疗降低了哮喘合并CRS患者对OCS药物的总体需求，但尽管如此，停药率仍很高。
