Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Rhinology. 2024 Aug 1;62(4):403-409. doi: 10.4193/Rhin23.452.
There is no known predictor for olfactory function recovery with dupilumab treatment in chronic rhinosinusitis with nasal polyps (CRSwNP). This study assessed whether patient-reported recovery of olfactory function on oral corticosteroids (OCS) is a prognostic factor.
Retrospective analysis of pre-biological OCS-responsiveness on olfactory functioning (OCS-responsive or OCS-unresponsive; OCS-r and OCR-u, respectively) as predictor for olfactory functioning after 6 months of dupilumab therapy for severe CRSwNP.
212 CRSwNP patients treated with dupilumab were divided between OCS-r (reported improvement of olfactory function with OCS before dupilumab treatment, n = 152), and OCS-u (OCS-unresponsive; no such improvement, n = 60). Olfactory function was tested with Sniffin's Sticks Identification Test (12 pens; SSIT-12). At baseline, both groups had a median SSIT-12 score of 3 / 12 indicating anosmia. Hyposmia and normosmia rates were also comparable (5.9% and 3.3% in OCS-r, respectively; 5.0% and 1.7% in OCS-u, respectively). After 6 months of dupilumab treatment, OCS-r showed higher olfactory scores (median SSIT-12: 8/12; 52.6% hyposmia and 17.8% normosmia) than OCS-u (median SSIT-12: 5/12; 31.7% hyposmia and 3.3% normosmia). The positive predictive value of OCS-responsiveness on scoring <7 (normosmia/hyposmia) on the SSIT-12 after 6 months of dupilumab treatment was 70.4%. Conversely, the negative predictive value of OCS-unresponsiveness on scoring <7 (anosmia) on the SSIT-12 after 6 months of dupilumab treatment was 65.0%.
Patients who report olfactory function improvement on OCS have a higher chance of recovery of olfactory function during the first six months of treatment with dupilumab than patients who do not.
目前尚不清楚在伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）患者中，使用度普利尤单抗治疗后嗅觉功能恢复的预测因素。本研究评估了患者在口服皮质类固醇（OCS）治疗中嗅觉功能的恢复是否是一个预后因素。
本研究为回顾性分析，在开始接受生物制剂治疗之前，评估 OCS 对嗅觉功能的反应性（OCS 反应性或 OCS 无反应性；OCS-r 和 OCR-u）作为预测因子，以评估严重 CRSwNP 患者在接受度普利尤单抗治疗 6 个月后的嗅觉功能。
212 例接受度普利尤单抗治疗的 CRSwNP 患者被分为 OCS-r（在接受度普利尤单抗治疗前，报告 OCS 治疗后嗅觉功能改善，n = 152）和 OCS-u（OCS 无反应性；无改善，n = 60）。嗅觉功能使用 Sniffin' Sticks 识别测试（12 支笔；SSIT-12）进行测试。在基线时，两组的 SSIT-12 评分中位数均为 3 / 12，提示为嗅觉丧失。嗅觉减退和嗅觉正常的比例也相似（OCS-r 组分别为 5.9%和 3.3%；OCS-u 组分别为 5.0%和 1.7%）。在接受度普利尤单抗治疗 6 个月后，OCS-r 的嗅觉评分更高（SSIT-12 中位数：8/12；52.6%嗅觉减退和 17.8%嗅觉正常），而 OCS-u 的嗅觉评分更低（SSIT-12 中位数：5/12；31.7%嗅觉减退和 3.3%嗅觉正常）。在接受度普利尤单抗治疗 6 个月后，OCS-反应性对 SSIT-12 评分<7（嗅觉减退/嗅觉正常）的阳性预测值为 70.4%。相反，OCS-无反应性对 SSIT-12 评分<7（嗅觉丧失）的阴性预测值为 65.0%。
与未报告 OCS 治疗后嗅觉功能改善的患者相比，报告 OCS 治疗后嗅觉功能改善的患者在接受度普利尤单抗治疗的前 6 个月内嗅觉功能恢复的可能性更高。
