Barroso B, Valverde-Monge M, Betancor D, Gómez-López A, Villalobos-Vilda C, González-Cano B, Sastre J
Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
J Investig Allergol Clin Immunol. 2023 Dec 14;33(6):419-430. doi: 10.18176/jiaci.0939. Epub 2023 Sep 4.
Impairment of smell is more commonly related to chronic rhinosinusitis with nasal polyps (CRSwNP) than without, especially when asthma and/or NSAID-exacerbated respiratory disease and type 2 inflammation are also present. Therapeutic options include intranasal and systemic corticosteroids, surgery, and, more recently, biological therapy. We summarize current knowledge on the effect of biologics on olfaction in patients with CRSwNP.
We performed a systematic search of the PubMed and Cochrane databases from January 2001 to June 2022. The inclusion criteria were as follows: adult patients with CRS treated with dupilumab, omalizumab, mepolizumab, benralizumab, or reslizumab; and studies published in English reporting outcomes for sense of smell based on psychophysical and/or subjective tools. We excluded reports that did not assess CRSwNP, loss of smell evaluated with a method other than those accepted in the inclusion criteria, review articles, and expert opinions. No funding was received.
Dupilumab has demonstrated rapid and sustained long-term improvement in smell in clinical trials and in real life. Omalizumab improves smell at 24 weeks. This improvement is maintained in the long-term, although it is not clinically relevant. Mepolizumab and benralizumab improved smell in the long term based on a subjective scale. No studies examining the improvement in smell in patients with CRSwNP treated with reslizumab were found. Indirect comparisons by meta-analysis consistently conclude that dupilumab is the most effective biologic for improving impaired sense of smell.
Dupilumab seems to be more efficacious for improving the sense of smell than omalizumab, mepolizumab, and benralizumab.
嗅觉障碍在伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）患者中比不伴有鼻息肉的患者更为常见，尤其是当同时存在哮喘和/或非甾体抗炎药诱发的呼吸道疾病以及2型炎症时。治疗选择包括鼻内和全身使用糖皮质激素、手术，以及最近出现的生物疗法。我们总结了目前关于生物制剂对CRSwNP患者嗅觉影响的知识。
我们对2001年1月至2022年6月的PubMed和Cochrane数据库进行了系统检索。纳入标准如下：接受度普利尤单抗、奥马珠单抗、美泊利单抗、贝那利单抗或瑞利珠单抗治疗的成年CRS患者；以及以英文发表的、基于心理物理学和/或主观工具报告嗅觉结果的研究。我们排除了未评估CRSwNP的报告、使用纳入标准以外方法评估嗅觉丧失的报告、综述文章和专家意见。未接受任何资助。
度普利尤单抗在临床试验和实际应用中均显示出嗅觉的快速和持续长期改善。奥马珠单抗在24周时改善嗅觉。这种改善在长期内得以维持，尽管在临床上并不显著。基于主观量表，美泊利单抗和贝那利单抗在长期内改善了嗅觉。未找到关于瑞利珠单抗治疗CRSwNP患者嗅觉改善情况的研究。通过荟萃分析进行的间接比较一致得出结论，度普利尤单抗是改善嗅觉障碍最有效的生物制剂。
度普利尤单抗在改善嗅觉方面似乎比奥马珠单抗、美泊利单抗和贝那利单抗更有效。
