Foerster-Ruhrmann Ulrike, Jurkov Miroslav, Szczepek Agnieszka J, Bergmann Karl-Christian, Fluhr Joachim W, Olze Heidi
Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität and Berlin Humboldt Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany.
Biomedicines. 2024 May 7;12(5):1025. doi: 10.3390/biomedicines12051025.
Non-steroidal anti-inflammatory drugs (NSAIDs) exacerbated respiratory disease (N-ERD) is associated with chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and NSAID hypersensitivity. An overproduction of leukotrienes characterizes the pathomechanism of the disease. N-ERD patients often report breathing difficulties after consuming alcohol. These symptoms have been observed in patients receiving either aspirin therapy after desensitization (ATAD), therapy with the biologics dupilumab (anti-IL-4Ra antibody) and omalizumab (anti-IgE antibody), or intranasal corticosteroid treatment (INCS).
This retrospective, real-world study assessed the severity of alcohol-related and non-alcohol-related respiratory symptoms in CRSwNP/N-ERD patients 3-6 months after ATAD, biologic (dupilumab or omalizumab), or INCS therapy. A total of 171 patients (98 women and 73 men) were enrolled in the study. All groups received standard INCS therapy. Sixty-three patients were treated with ATAD; 48 received biologics (dupilumab = 31; omalizumab = 17); and 60 received INCS only and served as a control group. Alcohol-dependent symptoms and typical CRS symptoms (alcohol-independent) were quantified using visual analog scales (VAS).
ATAD and biological therapy significantly reduced VAS scores for alcohol dependence and CRS symptoms. In the control group receiving INCS, only non-alcohol dependent CRS symptoms improved significantly ( < 0.05). The most significant differences in pre/post scores were observed in patients receiving dupilumab, with the most significant improvement in alcohol-dependent and CRS symptoms (dupilumab > omalizumab > ATAD).
This real-world study shows that alcohol-related respiratory symptoms are a relevant parameter in CRSwNP/N-ERD patients. Patients benefit more from biologic therapy than from ATAD in terms of their alcohol-related symptoms and other CRS symptoms. Future studies should include placebo-controlled oral alcohol challenge.
非甾体抗炎药加重性呼吸道疾病（N-ERD）与伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）、哮喘及非甾体抗炎药超敏反应相关。白三烯产生过多是该疾病发病机制的特征。N-ERD患者常在饮酒后出现呼吸困难。在接受阿司匹林脱敏治疗（ATAD）、使用生物制剂度普利尤单抗（抗IL-4Ra抗体）和奥马珠单抗（抗IgE抗体）治疗或鼻内糖皮质激素治疗（INCS）的患者中均观察到了这些症状。
这项回顾性的真实世界研究评估了CRSwNP/N-ERD患者在接受ATAD、生物制剂（度普利尤单抗或奥马珠单抗）或INCS治疗3至6个月后与酒精相关及与酒精无关的呼吸道症状的严重程度。共有171例患者（98例女性和73例男性）纳入研究。所有组均接受标准的INCS治疗。63例患者接受ATAD治疗；48例接受生物制剂治疗（度普利尤单抗 = 31例；奥马珠单抗 = 17例）；60例仅接受INCS治疗并作为对照组。使用视觉模拟量表（VAS）对酒精依赖症状和典型的CRS症状（与酒精无关）进行量化。
ATAD和生物制剂治疗显著降低了酒精依赖和CRS症状的VAS评分。在接受INCS治疗的对照组中，仅与酒精无关的CRS症状有显著改善（<0.05）。接受度普利尤单抗治疗的患者在治疗前后评分的差异最为显著，酒精依赖和CRS症状改善最为明显（度普利尤单抗>奥马珠单抗>ATAD）。
这项真实世界研究表明，与酒精相关的呼吸道症状是CRSwNP/N-ERD患者的一个相关参数。就与酒精相关的症状和其他CRS症状而言，患者从生物制剂治疗中获益比从ATAD治疗中更多。未来的研究应包括安慰剂对照的口服酒精激发试验。
