Strauss J, Lochbaum R, Hoffmann T K, Mayer B, Appel H, Hahn J
Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland.
HNO. 2024 Jul;72(7):464-472. doi: 10.1007/s00106-024-01479-y. Epub 2024 May 3.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease, the treatment of which has undergone significant changes in recent years. In addition to surgical approaches, topical and systemic steroids, and adaptive acetylsalicylic acid (ASA) desensitization, three specific antibodies have complemented the therapeutic portfolio since 2019.
A retrospective evaluation of all patients who presented as outpatients for the first time due to CRSwNP in 2007 and 2008 (collective A) and 2017 and 2018 (collective B) was performed, up to and including June 2023.
The clinical courses of 463 patients (mean age 49.1 years, range 5-82 years; 65.9% male) were included in the analysis. Conservative treatment with nasal corticosteroids started before initial presentation was more frequent in collective B (collective A 43.9% vs. collective B 72.2%). In 278 of the 463 patients (60%; A: 62%, B: 58%), at least one operation on the nasal sinuses had been performed after initial presentation; in 101 of these patients (36.3%) recurrent polyposis (within mean follow-up of 2.4 years) required further treatment. The indication for ASA provocation/desensitization was applied less frequently in collective B, also due to a high discontinuation rate (at least 38%) of the maintenance therapy. Of the total cohort, 16 patients (3.5%; A: n = 8, B: n = 8) were meanwhile switched to antibody therapy at recurrence.
A step-by-step guideline-orientated approach is recommended in the treatment of CRSwNP. Systemic antibodies as an add-on to nasal corticosteroids are a relatively new therapeutic option for treatment-refractory CRSwNP, which reduces the indication for ASA desensitization, which is associated with a relatively high incidence of side effects and poor compliance.
伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种多因素炎症性疾病，其治疗方法近年来发生了显著变化。除了手术方法、局部和全身用类固醇以及适应性乙酰水杨酸（ASA）脱敏治疗外，自2019年以来，三种特异性抗体也被纳入了治疗方案。
对2007年和2008年（A组）以及2017年和2018年（B组）首次因CRSwNP作为门诊患者就诊的所有患者进行回顾性评估，随访至2023年6月。
分析纳入了463例患者的临床病程（平均年龄49.1岁，范围5 - 82岁；男性占65.9%）。在首次就诊前开始使用鼻用皮质类固醇进行保守治疗在B组更为常见（A组为43.9%，B组为72.2%）。在463例患者中的278例（60%；A组：62%，B组：58%）在首次就诊后至少接受了一次鼻窦手术；在这些患者中的101例（36.3%）出现复发性息肉（平均随访2.4年）需要进一步治疗。ASA激发/脱敏治疗的指征在B组应用较少，这也是由于维持治疗的停药率较高（至少38%）。在整个队列中，有16例患者（3.5%；A组：n = 8，B组：n = 8）在复发时转而接受抗体治疗。
建议在CRSwNP的治疗中采用逐步的、以指南为导向的方法。全身用抗体作为鼻用皮质类固醇的附加治疗是治疗难治性CRSwNP的一种相对较新的治疗选择，它减少了与相对高的副作用发生率和低依从性相关的ASA脱敏治疗的指征。
