Department of Allergy and Clinical Immunology, School of Medicine, Iran University of Medical Sciences, Hazrate Rasool Akram Hospital, Tehran, Iran.
Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Am J Rhinol Allergy. 2023 Jul;37(4):384-390. doi: 10.1177/19458924231154066. Epub 2023 Feb 5.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex disorder and effective treatment remains a major challenge. Some antibiotics with anti-inflammatory properties are reported to have potential to be used as an adjunct therapy in the management of chronic airway inflammation.
The aim of this study was to evaluate the efficacy of doxycycline in CRSwNP.
In this randomized, double-blind, placebo-control study, we assessed the efficacy of doxycycline in patients with moderate to severe CRSwNP. A total of 100 patients were randomly assigned to receive either doxycycline (200 mg on the first day followed by 100 mg daily) or placebo for 6 weeks. All patients received baseline therapy with fluticasone, montelukast, and nasal irrigation during the study. The primary outcome was quality of life based on the sino-nasal outcome test (SNOT-22) questionnaire. We measured peak nasal inspiratory flow (PNIF) and severity of symptoms by visual analogue scale (VAS). Baseline blood eosinophil count, serum IgE level, eosinophil in nasal secretions, and Lund-Mackay score based on low dose paranasal CT scan were also recorded.
Treatment with doxycycline significantly improved SNOT-22 (= .037) and sense of smell (= .048). The baseline SNOT-22 score had no effect on outcomes. The effect of doxycycline on quality of life in patients with or without nasal eosinophilia was not significantly different. Change in SNOT-22 score was also not correlated with serum IgE (= .220, = -0.186) and the eosinophil count (= .190, = -0.198).
Doxycycline improves the quality of life in patients with CRSwNP. It also has temporarily beneficial effects in improving the sense of smell. The levels of eosinophil in the blood and nasal secretions do not affect the response to treatment. Hence, doxycycline can be used in both eosinophilic and non-eosinophilic nasal polyps.This study was registered at Iranian Registry of Clinical Trials. https://www.irct.ir/ IRCTID: IRCT20210403050817N1.
慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）是一种复杂的疾病，有效的治疗仍然是一个主要挑战。一些具有抗炎特性的抗生素被报道具有作为慢性气道炎症管理辅助治疗的潜力。
本研究旨在评估多西环素在 CRSwNP 中的疗效。
在这项随机、双盲、安慰剂对照研究中，我们评估了多西环素在中重度 CRSwNP 患者中的疗效。共有 100 名患者被随机分为多西环素组（第 1 天 200mg，随后每天 100mg）或安慰剂组，治疗 6 周。所有患者在研究期间均接受氟替卡松、孟鲁司特和鼻腔冲洗的基础治疗。主要结局是基于鼻-鼻窦炎结局测试（SNOT-22）问卷的生活质量。我们通过峰值鼻吸气流量（PNIF）和视觉模拟量表（VAS）测量症状严重程度。还记录了基线时血液嗜酸性粒细胞计数、血清 IgE 水平、鼻分泌物中的嗜酸性粒细胞和基于低剂量鼻窦 CT 扫描的 Lund-Mackay 评分。
多西环素治疗显著改善了 SNOT-22（=0.037）和嗅觉（=0.048）。基线 SNOT-22 评分对结局无影响。多西环素对伴有或不伴鼻嗜酸性粒细胞增多的患者生活质量的影响无显著差异。SNOT-22 评分的变化也与血清 IgE（=0.220，=-0.186）和嗜酸性粒细胞计数（=0.190，=-0.198）无关。
多西环素可改善 CRSwNP 患者的生活质量，还可暂时改善嗅觉。血液和鼻分泌物中的嗜酸性粒细胞水平不影响治疗反应。因此，多西环素可用于治疗嗜酸性和非嗜酸性鼻息肉。本研究在伊朗临床试验注册中心注册。https://www.irct.ir/IRCTID：IRCT20210403050817N1。
