Chhiba Krishan D, Patel Gayatri B, Peters Anju T
Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Allergy Clin Immunol. 2025 Jan;155(1):24-30. doi: 10.1016/j.jaci.2024.11.011. Epub 2024 Nov 16.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition characterized by type 2 (T2) immune responses with significant impacts on quality of life and health care costs. Local IgE production in nasal polyp tissue plays a key role in the T2 inflammatory cascade. Omalizumab, an anti-IgE monoclonal antibody, is an effective treatment for some patients with CRSwNP regardless of the patient's allergic status. Clinical trials, including the pivotal POLYP 1 and POLYP 2 studies, demonstrated omalizumab's efficacy in reducing nasal polyp size, improving symptom scores, and enhancing quality of life, particularly in patients with comorbid asthma and aspirin-exacerbated respiratory disease. As we summarize in this review, omalizumab's effect appears to involve the reduction in local IgE and T2 inflammation; however, this remains poorly understood. Notably, omalizumab's effectiveness appears to be partially sustained after long-term therapy, though symptoms and inflammation begin to return at discontinuation. Ongoing research is needed to determine the optimal duration of therapy and potential for biologics to modify the disease course. Additionally, further studies are needed to identify biomarkers to predict treatment response and to compare omalizumab with other biologics such as dupilumab in head-to-head trials. Omalizumab is one of the key T2-targeted therapeutic options for CRSwNP, with sustained effectiveness and strong safety profile.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种慢性炎症性疾病，其特征为2型（T2）免疫反应，对生活质量和医疗费用有重大影响。鼻息肉组织中局部IgE的产生在T2炎症级联反应中起关键作用。奥马珠单抗是一种抗IgE单克隆抗体，无论患者的过敏状态如何，对一些CRSwNP患者都是一种有效的治疗方法。包括关键的POLYP 1和POLYP 2研究在内的临床试验证明，奥马珠单抗在缩小鼻息肉大小、改善症状评分和提高生活质量方面具有疗效，尤其是在合并哮喘和阿司匹林加重的呼吸道疾病的患者中。正如我们在本综述中总结的那样，奥马珠单抗的作用似乎涉及局部IgE和T2炎症的减少；然而，对此仍知之甚少。值得注意的是，尽管在停药后症状和炎症开始复发，但长期治疗后奥马珠单抗的有效性似乎部分得以维持。需要进行持续研究以确定最佳治疗持续时间以及生物制剂改变疾病进程的潜力。此外，还需要进一步研究以确定预测治疗反应的生物标志物，并在头对头试验中将奥马珠单抗与其他生物制剂（如度普利尤单抗）进行比较。奥马珠单抗是CRSwNP关键的T2靶向治疗选择之一，具有持续有效性和强大的安全性。
