Im Yeon Hee, Stybayeva Gulnaz, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.
Otolaryngol Head Neck Surg. 2025 Oct;173(4):840-847. doi: 10.1002/ohn.1339. Epub 2025 Jun 24.
Allergic fungal rhinosinusitis (AFRS) is characterized by type I immunoglobulin E (IgE)-mediated hypersensitivity reactions to fungal antigens. This systematic review and meta-analysis assessed the efficacy of biologics in the management of refractory AFRS.
PubMed, SCOPUS, Embase, Web of Science, and Cochrane.
Changes in Sino-Nasal Outcome Test (SNOT)-22 scores, endoscopic findings, serum eosinophil count, and total IgE levels were assessed in patients with refractory AFRS after receiving biologic therapy. Subgroup analyses were conducted to evaluate the individual efficacy of each biologic agent, including dupilumab, mepolizumab, and omalizumab.
A total of 60 patients from 6 studies were analyzed. Biologics showed a significant improvement in SNOT-22 scores (standard mean difference 1.1607 [95% CI 0.5549; 1.7664]), endoscopic scores (2.1953 [1.4181; 2.9725]), serum eosinophil count (1.1649 [0.7735; 1.5563]), and total IgE level (1.0700 [0.4052; 1.7348]). Dupilumab, mepolizumab, and omalizumab all enhanced SNOT-22 and endoscopic scores. Additionally, dupilumab significantly reduced total IgE levels (1.2981 [0.4063; 2.1900]), whereas both dupilumab (0.9274 [0.1592; 1.6957]) and mepolizumab (1.2324 [0.9215; 1.5433]) significantly lowered the serum eosinophil counts.
The agents significantly improved nasal symptoms, laboratory findings, and endoscopic scores. These findings support the potential role of biologics as a therapeutic option for patients with AFRS who are unresponsive to conventional treatments.
变应性真菌性鼻鼻窦炎（AFRS）的特征是对真菌抗原产生I型免疫球蛋白E（IgE）介导的超敏反应。本系统评价和荟萃分析评估了生物制剂在难治性AFRS治疗中的疗效。
PubMed、SCOPUS、Embase、Web of Science和Cochrane。
对接受生物治疗后的难治性AFRS患者的鼻鼻窦结局测试（SNOT）-22评分、内镜检查结果、血清嗜酸性粒细胞计数和总IgE水平的变化进行评估。进行亚组分析以评估每种生物制剂（包括度普利尤单抗、美泊利单抗和奥马珠单抗）的个体疗效。
共分析了来自6项研究的60例患者。生物制剂在SNOT-22评分（标准平均差1.1607 [95%可信区间0.5549；1.7664]）、内镜评分（2.1953 [1.4181；2.9725]）、血清嗜酸性粒细胞计数（1.1649 [0.7735；1.5563]）和总IgE水平（1.0700 [0.4052；1.7348]）方面显示出显著改善。度普利尤单抗、美泊利单抗和奥马珠单抗均提高了SNOT-22和内镜评分。此外，度普利尤单抗显著降低了总IgE水平（1.2981 [0.4063；2.1900]），而度普利尤单抗（0.9274 [0.1592；1.6957]）和美泊利单抗（1.2324 [0.9215；1.5433]）均显著降低了血清嗜酸性粒细胞计数。
这些制剂显著改善了鼻部症状、实验室检查结果和内镜评分。这些发现支持生物制剂作为对传统治疗无反应的AFRS患者的一种治疗选择的潜在作用。
