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Hung PT, Wang HS, Lee TJ, Huang CC, Chang PH, Chen YW, Fu CH. Serum Aspergillus fumigatus-Specific IgG as a Complementary Biomarker in Differentiating Endotypes of Chronic Rhinosinusitis: A Study on Its Role and Diagnostic Efficacy in Type 2 Inflammation. Am J Rhinol Allergy 2024; 38:316-323. [PMID: 38751051 DOI: 10.1177/19458924241253937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Aspergillus is one of the most common pathogens causing fungal allergy in the respiratory tract. Serum Aspergillus fumigatus-specific immunoglobulin G (Af-sIgG) levels have been used as a biomarker for the diagnosis and treatment response monitoring in airway allergic diseases such as allergic bronchopulmonary aspergillosis and allergic fungal rhinosinusitis. However, its role in common primary chronic rhinosinusitis (CRS) was unclear. OBJECTIVE This study aims to evaluate whether serum Af-sIgG level could serve as a biomarker for the disease presentation of primary CRS. METHODS We obtained serum Af-sIgG levels from patients diagnosed as bilateral primary CRS refractory to medical treatment and evaluated the correlations between serum Af-sIgG levels and disease severity in patients with type 2 (T2) and non-T2 CRS. RESULTS Patients with T2 CRS exhibited significantly higher serum Af-sIgG levels than non-T2 CRS patients. The cut-off value of serum Af-sIgG in T2 CRS was 20.9 mg/L, with an odds ratio of 3.8 (95% CI 1.17-12.20, P = .026). Furthermore, serum Af-sIgG levels were positively correlated with symptom scores evaluated by the Sino-Nasal Outcome Test-22 (SNOT-22) scores in T2 patients (P = .009). While stratified by SNOT-22 total scores, patients with severe disease had higher serum Af-sIgG levels only in T2 CRS (P = .034). In individual domains of SNOT-22 analysis, serum Af-sIgG levels showed a significant correlation with "ear/facial" symptom scores in the T2 group (P < .001). CONCLUSIONS Serum Af-sIgG levels may serve as a supplementary objective biomarker that correlates with identification and subjective measurements of T2 CRS, and may be associated with symptoms arising from Eustachian tube dysfunction.
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Affiliation(s)
- Pei-Tzu Hung
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsiang-Sheng Wang
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ta-Jen Lee
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chi-Che Huang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Hung Chang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chia-Hsiang Fu
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Talugula S, Chiu R, Nyenhuis SM, Eldeirawi K, Lee VS. Sex-based differences in severity of chronic rhinosinusitis as reported by SNOT-22 scores. Am J Otolaryngol 2024; 45:104465. [PMID: 39126758 DOI: 10.1016/j.amjoto.2024.104465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a widely prevalent condition, however its degree of severity according to sex requires further study. The literature shows that sex-based differences exist in the severity of asthma and allergic airway disease in the population. These findings point to a potential hormonal cause for this difference, but there is no study suggesting the role of sex in CRS with nasal polyps (CRSwNP). The purpose of this study was to examine the association of sex and CRSwNP severity in the United States. METHODS This study was conducted on data gathered from 181 participants in the NAVIGATE I and NAVIGATE II randomized control trials within the OPTINOSE database. Participants were analyzed based on sex controlling for airway-related comorbidities, including history of asthma, race, and ethnicity. SNOT-22 scores were assessed as a quality-of-life outcome measure for CRS. The association between sex and SNOT-22 scores was determined using multiple linear regression. RESULTS There were 81 female and 100 male participants. SNOT-22 scores were significantly higher in females. The average reported SNOT-22 score was 53.8 ± 16.5 in females and 46.8 ± 18.8 in males. On adjusted regression, the association of sex and SNOT-22 scores approached but didn't reach significance (β: -4.97; 95 % CI: -10.68-0.73; p = 0.09). CONCLUSIONS On average, females had more severe manifestations of CRSwNP in comparison to males, with the adjusted association approaching statistical significance. Further studies, potentially looking at hormones as a cause of pathogenesis, are needed to better elucidate the role of sex in CRSwNP.
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Affiliation(s)
- Snehitha Talugula
- University of Illinois College of Medicine, 1853 W Polk St, Chicago, IL 60612, USA.
| | - Richard Chiu
- University of Illinois College of Medicine, 1853 W Polk St, Chicago, IL 60612, USA
| | - Sharmilee M Nyenhuis
- University of Chicago, Department of Pediatrics, Section of Allergy and Immunology, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Kamal Eldeirawi
- University of Illinois Chicago, Department of Population Health Nursing Science, 845 S Damen Ave, Chicago, IL 60612, USA
| | - Victoria S Lee
- University of Illinois Chicago College of Medicine, Department of Otolaryngology-Head and Neck Surgery, 1853 W Polk St, Chicago, IL 60612, USA
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Rodriguez-Van Strahlen C, Arancibia C, Calvo-Henriquez C, Mullol J, Alobid I. Systematic Review of Long Term Sinonasal Outcomes in CRSwNP after Endoscopic Sinus Surgery: A call for Unified and Standardized Criteria and Terms. Curr Allergy Asthma Rep 2024; 24:443-456. [PMID: 38913122 PMCID: PMC11297087 DOI: 10.1007/s11882-024-01154-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW To present current evidence in long-term (> 5 years) results after endoscopic sinus surgery (ESS) focusing on Patients Reported Outcome Measures (PROMs) and other sinonasal outcomes while assessing the role of ESS in the treatment of CRSwNP, and identifying outcomes which affect the results of ESS and defining recommendations for future studies. RECENT FINDINGS Long-term results of ESS in CRSwNP can be branched in PROMs and other objective measurements. Despite the heterogeneity of reported outcomes make it difficult to perform comparisons and meta-analysis, ESS improves PROMs, including symptoms, QOL and olfaction. Objectives outcomes such as NPS, LMS, type of surgery, or recurrence and revision surgery don't have a clear role in long-term results. Clustering patients suggest asthma, N-ERD, allergy, eosinophil count and IL-5 could have a role in predicting recurrence and severe disease. Long-term studies of CRSwNP treated with ESS are scarce. There is a significant need to standardize the report of results. The use of tools as SNOT-22, NPS, validated smell tests, defined criteria for disease recurrence and control and ESS extension in a unified systematic way could allow better comparisons between treatments in the new era of biologics.
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Affiliation(s)
- Camilo Rodriguez-Van Strahlen
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain.
- Universitat de Barcelona, Barcelona, Spain.
| | - Claudio Arancibia
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Oto rhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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4
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Tajiri T, Suzuki M, Nishiyama H, Ozawa Y, Kurokawa R, Ito K, Fukumitsu K, Mori Y, Kanemitsu Y, Fukuda S, Uemura T, Ohkubo H, Takemura M, Maeno K, Ito Y, Oguri T, Iwasaki S, Niimi A. Efficacy of dupilumab for severe chronic rhinosinusitis with nasal polyps and asthma: A prospective study. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00422-8. [PMID: 38972450 DOI: 10.1016/j.anai.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Dupilumab exerts clinical effects, including improved sinus opacification, olfactory function, and quality of life, in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNPs). Meanwhile, only a few studies have reported its effects on nasal airway resistance and olfactory function, particularly in the Japanese population. Predictors of response remain unclear. OBJECTIVE To assess the comprehensive efficacy and therapeutic response to dupilumab in patients with severe CRSwNP with comorbid asthma. METHODS In 16 adult patients with severe CRSwNP with comorbid asthma, the efficacy of 48-week dupilumab treatment, including olfactory function measured by a T&T olfactometer, nasal airway resistance measured by rhinomanometry, nasal polyp score, Lund-Mackay computed tomography score, and 22-item Sinonasal Outcome Test (SNOT-22), was assessed. Regarding asthma, the annualized rate of exacerbations, 7-item Asthma Control Questionnaire (ACQ-7), and spirometry were assessed. Treatment responsiveness was analyzed. RESULTS With 48-week dupilumab treatment, olfactory function, nasal airway resistance, nasal polyp score, Lund-Mackay computed tomography score, and SNOT-22 scores improved significantly. Regarding comorbid asthma, the annualized rate of exacerbations decreased, and ACQ-7 scores and lung function improved significantly. According to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020/European Forum for Research and Education in Allergy and Airway Diseases criteria, 15 patients (94%) were moderate-to-excellent responders at 48 weeks of treatment. Patients with higher SNOT-22 scores, ACQ-7 scores, the rate of asthma exacerbations in the previous year, and blood eosinophil counts benefited more from the treatment. CONCLUSION Dupilumab improved upper and lower airway outcomes especially in patients with severe CRSwNP with comorbid, poorly controlled asthma. TRIAL REGISTRATION UMIN Clinical Trials Registry: UMIN000038669.
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Affiliation(s)
- Tomoko Tajiri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan.
| | - Motohiko Suzuki
- Department of Otorhinolaryngology & Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Hirono Nishiyama
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yoshiyuki Ozawa
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Ryota Kurokawa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Keima Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yuta Mori
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Takehiro Uemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Shinichi Iwasaki
- Department of Otorhinolaryngology & Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
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Meltzer EO, Mullol J, Ko J, Saenz R, Steinke JW, Millette LA, Gevaert P. Omalizumab improves sleep and health status for patients with chronic rhinosinusitis with nasal polyps: An analysis of randomized clinical trials. Int Forum Allergy Rhinol 2024; 14:1163-1172. [PMID: 38197558 DOI: 10.1002/alr.23322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have high incidence of sleep impairment. We evaluated the impact of omalizumab treatment on sleep characteristics and associated health status in patients with CRSwNP. METHODS Prespecified exploratory analysis assessed outcomes from patients included in the POLYP 1 and POLYP 2 phase 3 clinical trials and the open-label extension. Sleep was assessed by the sleep domain of the Sino-Nasal Outcome Test-22 (SNOT-22; MCID > 4 in patients with CRS) and the Medical Outcomes Study Sleep Scale (MOS-Sleep). Health status was assessed by Healthy Days Core Module (HDCM) and sinonasal-specific Patient Global Impression of Change (PGIC). RESULTS Omalizumab improved sleep as assessed by the SNOT-22 sleep domain. At week 24, adjusted mean (95%CI) SNOT-22 sleep scores had reduced from baseline by -8.5 (-9.9 to -7.1) with omalizumab versus -2.7 (-4.1 to -1.3) with placebo. At week 52 (all patents on OMA), adjusted mean (95%CI) SNOT-22 sleep scores had reduced from baseline by -10.1 (-11.4 to -8.7) with omalizumab. Improvements were observed in all eight items of the SNOT-22 sleep domain: difficulty falling asleep, fatigue, frustration/restlessness/irritability, lack good night's sleep, reduced concentration, reduced productivity, wake up tired, and wake up at night. In addition, omalizumab improved six of eight sleep outcomes on the MOS-Sleep scale. There were concurrent improvements in HDCM and PGIC. CONCLUSION Omalizumab improved sleep and self-reported health status in patients with CRSwNP. This contributes to evidence that omalizumab provides value for patients beyond the reduction of sinonasal symptoms.
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Affiliation(s)
- Eli O Meltzer
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, California, USA
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Jinnie Ko
- Genentech, Inc., South San Francisco, California, USA
| | - Rebecca Saenz
- Genentech, Inc., South San Francisco, California, USA
| | | | | | - Philippe Gevaert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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6
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Heiland LD, Farmer HG, Nguyen SA, Soler ZM, Schlosser RJ. Headache and Facial Pain/Pressure in the Chronic Rhinosinusitis Population: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38895867 DOI: 10.1002/ohn.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the severity and prevalence of headache and facial pain/pressurere in the chronic rhinosinusitis (CRS) population. DATA SOURCES CINAHL, PubMed, Scopus. REVIEW METHODS The literature was searched from inception through June 2023 for English language articles documenting "headache" or "facial pain/pressure" and "chronic rhinosinusitis." Data collected included Lund-MacKay computed tomography score, Lund-Kennedy endoscopy score, sinonasal outcome test, and visual analog scale. Meta-analyses were performed on continuous measures (mean), proportions (%), and regression. RESULTS A total of 69 studies were included with 8643 CRS patients and 703 control patients. The CRS group had a mean age of 44.1 (range: 16-82; 95% confidence interval [CI]: 40.3-48) and 86.1% [95% CI: 76.4-93.5] with nasal polyposis. The control group had a mean age of 39.2 (range: 17-88; 95% CI: 28.7-49.8). All CRS subgroups had significantly more severe headache and facial pain/pressure when compared to the control (P < .0001). Patients without polyps had significantly more severe facial pain/pressure and headache when compared to patients with polyps (P < .0001). Facial pain/pressure is a moderate problem or worse in 29.8% of polypoid patients versus 56.4% of nonpolypoid patients; Δ26.6% [95% CI: 0.7-50; P = .045]. CONCLUSIONS Across all outcome metrics, CRS patients experience significantly more severe headache and facial pain/pressure when compared to a control population. Nonpolypoid patients experience significantly more severe facial pain/pressure and headache when compared to polypoid patients. The majority of nonpolypoid patients experience facial pain/pressure that is moderate in severity or worse.
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Affiliation(s)
- Luke D Heiland
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Hannah G Farmer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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7
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Fokkens WJ, Bachert C, Hopkins C, Marglani O, Praestgaard A, Nash S, Deniz Y, Rowe PJ, Sacks H, Jacob‐Nara JA. Dupilumab improves outcomes in patients with chronic rhinosinusitis with nasal polyps irrespective of gender: results from the SINUS-52 trial. Clin Transl Immunology 2024; 13:e1511. [PMID: 38854740 PMCID: PMC11161870 DOI: 10.1002/cti2.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives This post hoc analysis assessed disease characteristics and response to dupilumab treatment in male and female patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) (SINUS-52 study; NCT02898454). Methods Patients received dupilumab 300 mg or placebo every 2 weeks for 52 weeks on background intranasal corticosteroids. Efficacy was assessed through Week 52 using nasal polyp score (NPS), nasal congestion/obstruction score, loss of smell score and University of Pennsylvania Smell Identification Test score. Disease-specific health-related quality of life (HRQoL) was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Results The analysis included 192 male and 111 female patients. Female patients had higher mean SNOT-22 total score (56.6 vs. 49.1, P < 0.01) and more coexisting asthma (78.4% vs. 46.4%, P < 0.0001) and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) (38.7% vs. 18.8%, P = 0.0001) than male patients, but other baseline characteristics were similar. Dupilumab significantly improved CRSwNP outcomes vs. placebo at Week 52, regardless of gender: least squares mean differences (95% confidence interval) for NPS were -2.33 (-2.80, -1.86) in male and -2.54 (-3.18, -1.90) in female patients (both P < 0.0001 vs. placebo), and for SNOT-22 were -19.2 (-24.1, -14.2) in male and -24.4 (-31.5, -17.3) in female patients (both P < 0.0001 vs. placebo). There were no significant efficacy-by-gender interactions. Conclusion Female patients had greater asthma, NSAID-ERD and HRQoL burden at baseline than male patients. Dupilumab treatment significantly improved objective and subjective outcomes compared with placebo, irrespective of gender.
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Affiliation(s)
- Wytske J Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Claus Bachert
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity Hospital of MünsterMünsterGermany
- International Airway Research CenterFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Claire Hopkins
- Department of OtorhinolaryngologyKing's College LondonLondonUK
| | - Osama Marglani
- Department of Ophthalmology and Otolaryngology – Head and Neck SurgeryUmm Al‐Qura UniversityMakkahSaudi Arabia
- King Faisal Specialist Hospital and Research CenterJeddahSaudi Arabia
| | | | - Scott Nash
- Medical AffairsRegeneron Pharmaceuticals Inc.TarrytownNYUSA
| | - Yamo Deniz
- Medical AffairsRegeneron Pharmaceuticals Inc.TarrytownNYUSA
| | - Paul J Rowe
- Global Medical AffairsSanofiBridgewaterNJUSA
| | - Harry Sacks
- Medical AffairsRegeneron Pharmaceuticals Inc.TarrytownNYUSA
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Alegre Edo B, Rojas-Lechuga MJ, Quer-Castells M, González-Sánchez N, Lopez-Chacon M, Hopkins C, Alobid I. Quality of Life in Symptomatic Septal Perforation. Laryngoscope 2024. [PMID: 38850257 DOI: 10.1002/lary.31557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE The aim of this study is to investigate the impact of septal perforation (SP) on quality of life (QoL). SP is compared to the general population and patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) using the Sino-Nasal Outcome Test 22 (SNOT-22). METHODS Prospective single-center study in a referral Rhinology Unit from January 2014 to March 2023. RESULTS A total of 392 patients were included in three groups: controls (n = 141), CRSwNP (n = 118), and SP (n = 133). The mean score of the SNOT-22 was significantly higher in the CRSwNP group (42.4, SD = 24.4) and SP (46.5, SD = 22) compared to the control group (6.2, SD = 8.4). Scores by either items or domains were significantly higher in the CRSwNP and SP groups compared to the control group. There were no significant differences in the mean SNOT-22 between the CRSwNP and SP groups (p = 0.26; 95% CI -1.68-9.99). Domain-specific analysis of overall SNOT-22 scores revealed that patients with SP experienced higher levels of disturbances in sleep, function, and psychological domains (p ≤ 0.001). CONCLUSION SP produces a negative impact on QoL similar to CRSwNP. Moreover, sleep, psychological, and function domains are significantly worse in SP. Etiology and area of SP influence nasal and emotion domain, though more studies on SP using SNOT-22 and specific questionnaires are needed. LEVEL OF EVIDENCE Level III Laryngoscope, 2024.
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Affiliation(s)
- Berta Alegre Edo
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - María Jesús Rojas-Lechuga
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Mireia Quer-Castells
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Nesly González-Sánchez
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Mauricio Lopez-Chacon
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Isam Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
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9
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Alsaleh S, Kamal N, Hopkins C, Al Rand H, Marglani OA, Alterki A, Abu Suliman O, Alandejani T, Kamel R, Al Abri R, Alotaibi NH, Al Amadi A, Bahakim A, Han JK, Javer A, Sedaghat AR, Gevaert P. Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool. Laryngoscope Investig Otolaryngol 2024; 9:e1277. [PMID: 38803462 PMCID: PMC11129554 DOI: 10.1002/lio2.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Background Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. Conclusion The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence Oxford Level 3.
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Affiliation(s)
- Saad Alsaleh
- Department of Otolaryngology—Head and Neck Surgery, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Nehal Kamal
- Global Medical Immunology – Specialty CareSanofiUnited Arab Emirates
| | | | - Hussain Al Rand
- Health Centers and Clinics and Public HealthMinistry of HealthAbu DhabiUnited Arab Emirates
| | - Osama A. Marglani
- The Department of Ophthalmology and Otolaryngology, College of MedicineUmm Al‐Qura UniversityMakkahSaudi Arabia
- Department of OtolaryngologyKing Faisal Specialist Hospital & Research CenterJeddahSaudi Arabia
| | - Abdulmohsen Alterki
- Department of Otolaryngology, Head and Neck SurgeryZain and Al Sabah HospitalsKuwait CityKuwait
- Medical DepartmentDasman Diabetes InstituteKuwait CityKuwait
| | - Omar Abu Suliman
- Department of Rhinology, Sinus, and Skull Base SurgeryKing Abdullah Medical CityMakkahSaudi Arabia
| | - Talal Alandejani
- Department of Surgery, Faculty of MedicineKing Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Reda Kamel
- ENT Department, Kasr Al‐Ainy Faculty of MedicineCairo UniversityCairoEgypt
| | - Rashid Al Abri
- ENT Division, Department of Surgery, College of Medicine & Health SciencesSultan Qaboos UniversityMuscatSultanate of Oman
| | - Naif H. Alotaibi
- Otolaryngology, Head & Neck Surgery Department, King Faisal Specialist Hospital and Research CenterAlfaisal UniversityRiyadhSaudi Arabia
| | - Ahmad Al Amadi
- ENT DepartmentAl Kuwait Hospital, Ministry of HealthDubaiUnited Arab Emirates
| | - Abdullah Bahakim
- Department of Otolaryngology, Head, and Neck SurgeryKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Joseph K. Han
- Department of Otolaryngology ‐ Head and Neck SurgeryEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Amin Javer
- Rhinology and Skull Base Surgery, St. Paul's Sinus Center, Division of OtolaryngologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ahmad R. Sedaghat
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of OtorhinolaryngologyGhent UniversityGhentBelgium
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10
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Altonji S, Del Risco A, Kilpatrick KW, Kuchibhatla M, Hachem RA, Jang DW. Predictors of Non-Rhinogenic Facial Pain or Pressure in Otolaryngology Clinic. Otolaryngol Head Neck Surg 2024; 170:1314-1318. [PMID: 38219742 PMCID: PMC11058021 DOI: 10.1002/ohn.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/05/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES Identify demographic and clinical characteristics that may help differentiate non-rhinogenic facial pain or pressure (NRFP) from sinusitis. STUDY DESIGN Retrospective single-institution study. SETTING Tertiary Care Center Rhinology Clinic. METHODS All patients presenting with a complaint of facial pain or pressure over a 3-year period were included. Patients were categorized into either NRFP or sinusitis groups based on computed tomography imaging and nasal endoscopy. Data pertaining to demographics, history, and SNOT-22 questionnaire domains were compared via univariate analysis as well as logistic regression with backwards variable selection. RESULTS A total of 296 patients met inclusion criteria, of which 128 had NRFP and 168 had sinusitis. A significantly greater percentage of patients in the NRFP group were women of childbearing age (40.6% vs 28.0%, P = .02). Backwards variable selection resulted in a model with four variables predicting a diagnosis of NRFP-female sex (odds ratio [OR] = 2.998, P < .0001), no history of prior sinonasal surgery (OR = 0.340 for history vs no history, P < .01), low nasal domain score (OR = 0.551, P < .0001), and high ear/facial domain score (OR = 1.453, P < .01). CONCLUSION Accurately identifying patients with NRFP at initial presentation based on history would help direct patients to the appropriate care pathway and prevent ineffective treatments such as antibiotics and sinus procedures. Our findings suggest that the suspicion for NRFP should be higher in women of child-bearing age as well as patients with greater ear/facial symptoms or lesser nasal symptoms.
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Affiliation(s)
- Samuel Altonji
- Department of Head and Neck Surgery and Communication Sciences, Duke University
| | | | | | | | - Ralph Abi Hachem
- Department of Head and Neck Surgery and Communication Sciences, Duke University
| | - David W. Jang
- Department of Head and Neck Surgery and Communication Sciences, Duke University
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11
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Ottaviano G, Roccuzzo G, Lora L, Bison E, Tosin E, Calvanese L, Cestaro W, Locatello LG, Corlianò F, Stellin M, Baldovin M, Trimarchi MV, Bertocco AG, Maculan M, Scarpa B, Saccardo T, Nicolai P. The Impact of Dupilumab on Work Productivity and Emotional Health in CRSwNP: A Multicentric Study in Northeast Italy. J Pers Med 2024; 14:468. [PMID: 38793051 PMCID: PMC11121907 DOI: 10.3390/jpm14050468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) in the severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with Dupilumab in different rhinological units were considered for this study via their evaluation at the baseline at first and the consequential follow-up at 6-, 12-, and 24 months from the first administration. At baseline (T0) and at each follow-up, patients underwent NPS, Sinonasal Outcome Test (SNOT)-22, Visual Analogue Scale (VAS) for smell, and Sniffin' sticks identification test (SSIT). The SNOT-22 domains for function and emotion were also analysed separately. Two hundred and seventeen patients with at least 6 months of follow-up were included. All parameters have improved during treatment (p < 0.0001). Noticeably, both the function and emotion SNOT-22 domains have improved within 6 months of treatment and have continued to progress during every interval within 12 months from the baseline, positively influencing patients' emotivity and augmenting their social and economic performances. Dupilumab improves the QoL of CRSwNP patients with good effects on the reported productivity and emotional health. Clinicians should pay attention to these two aspects when dealing with patients affected by severe CRSwNP.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Giuseppe Roccuzzo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Lucia Lora
- ENT Department, Ospedale dell’Angelo, ULSS 3 Serenissima, Mestre, 30174 Venezia, Italy
| | | | - Enrico Tosin
- ENT Department, Hospital of Rovigo, 45100 Rovigo, Italy
| | - Leonardo Calvanese
- ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy
| | - Walter Cestaro
- ENT Consultant, Head and Neck Department, ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, University Hospital “Santa Maria Della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy;
| | - Fabrizio Corlianò
- Department of Otolaryngology Head and Neck Surgery, San Bassiano Hospital, Via Dei Lotti 40, 36061 Bassano Del Grappa, Italy
| | - Marco Stellin
- Department of Neurosciences, Section of Otolaryngology, University of Padova, 31100 Treviso, Italy;
| | - Maria Baldovin
- ENT Unit, Ospedale San Martino, Belluno, ULSS1 Dolomiti, 32100 Belluno, Italy
| | | | - Anna Giulia Bertocco
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Marco Maculan
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, 35122 Padova, Italy;
| | - Tommaso Saccardo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Piero Nicolai
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
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12
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Hopkins C, Mullol J, Khan AH, Lee SE, Wagenmann M, Hellings P, Fokkens W, Msihid J, Nair R, Kamat S, Nash S, Radwan A, Jacob-Nara JA, Deniz Y, Rowe PJ. Impact of Dupilumab on Sinonasal Symptoms and Outcomes in Severe Chronic Rhinosinusitis With Nasal Polyps. Otolaryngol Head Neck Surg 2024; 170:1173-1182. [PMID: 38156522 DOI: 10.1002/ohn.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES To assess the severity of the top 5 22-item Sino-Nasal Outcome Test (SNOT-22) items ranked most important by patients with chronic rhinosinusitis with nasal polyps (CRSwNP), the effect of dupilumab on these items, and their association with objective disease measures. STUDY DESIGN Post hoc analysis of the SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) clinical trials. SETTING Multinational, multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. METHODS Patients ranked the SNOT-22 items most affecting their health at baseline. Item symptom severity (0-5 scale) was assessed at baseline, Week 24 (W24), and Week 52 (W52). Changes in nasal polyps score (NPS) and Lund-Mackay (LMK) scores were assessed in patients with/without SNOT-22 items improvements of at least 1 severity group point at W24 and W52. RESULTS The SNOT-22 items ranked most important at baseline were "decreased sense of smell/taste" (87% of patients), followed by "nasal blockage" (82%), "postnasal discharge" (40%), "thick nasal discharge" (37%), and "wake up at night" (26%); 82%, 61%, 32%, 40%, and 26% of patients reported severe symptoms (score 4 or 5) for these items, respectively. Dupilumab improved score severity for all top 5 items versus placebo at W24 and W52. Improvements in NPS and LMK scores were numerically greater in patients with improvements in the SNOT-22 top 5 items. CONCLUSION Loss of smell/taste was ranked as the most important symptom by patients with CRSwNP. Dupilumab reduced the severity of the top 5 most important SNOT-22 items versus placebo, in parallel with improvements in objective disease measures. CLINICAL TRIAL REGISTRATION SINUS-24 and SINUS-52 clinical trials were registered with ClinicalTrials.gov, identifiers NCT02912468 and NCT02898454, respectively.
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Affiliation(s)
- Claire Hopkins
- Department of Otorhinolaryngology, King's College London, London, UK
| | - Joaquim Mullol
- Hospital Clínic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | - Stella E Lee
- Harvard Medical School, Brigham and Women's Hospital, Division of Otolaryngology-Head & Neck Surgery, Boston, Massachusetts, USA
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Peter Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wytske Fokkens
- Department of Otorhinolaryngology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jérôme Msihid
- Health Economics and Value Assessment, Sanofi, Gentilly, France
| | - Radhika Nair
- Health Economics and Value Assessment, Sanofi, Cambridge, Massachusetts, USA
| | - Siddhesh Kamat
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Amr Radwan
- Global Medical Affairs, Regeneron Pharmaceuticals Inc., Uxbridge, UK
| | | | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, New Jersey, USA
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13
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McDonald VM, Hamada Y, Agusti A, Gibson PG. Treatable Traits in Asthma: The Importance of Extrapulmonary Traits-GERD, CRSwNP, Atopic Dermatitis, and Depression/Anxiety. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:824-837. [PMID: 38278324 DOI: 10.1016/j.jaip.2024.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024]
Abstract
Treatable traits is a personalized medicine approach to the management of airway disease. Assessing traits within the 3 domains of pulmonary, extrapulmonary, and behavioral/lifestyle/risk factor traits, and applying targeted treatments to effectively manage these traits, enables a holistic and personalized approach to care. Asthma is a heterogeneous and complex airway disease that is frequently complicated by several extrapulmonary traits that impact asthma outcomes and predict future outcomes. We propose that the identification of extrapulmonary and behavioral risk factor traits and the implementation of targeted therapy will lead to improved management of people with asthma. Furthermore, many extrapulmonary traits present as "connected comorbidities"; that is, they coexist with asthma, have an impact on asthma, and effective treatment improves both asthma and the comorbidity or the comorbidities may share a similar mechanism. In this review, we explore this concept and look at atopic dermatitis, chronic rhinosinusitis with nasal polyps, gastroesophageal reflux disease, anxiety, and depression as treatable traits of asthma and how these can be managed using this approach.
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Affiliation(s)
- Vanessa M McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia.
| | - Yuto Hamada
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Peter G Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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14
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Alshatti A, Webb C. Biologics versus functional endoscopic sinus surgery for the treatment of chronic rhinosinusitis with nasal polyps: a literature review. J Laryngol Otol 2024; 138:361-366. [PMID: 37993118 DOI: 10.1017/s0022215123002177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To review the literature comparing functional endoscopic sinus surgery to dupilumab for the treatment of chronic rhinosinusitis with nasal polyps, in terms of symptom control, cost-effectiveness and complications. METHOD A literature review was conducted using PubMed, ScienceDirect and Cochrane databases. Data were extracted manually. RESULTS A total of six papers relevant to the main objective were found. CONCLUSION Chronic rhinosinusitis with nasal polyps has a significant impact on patients' quality of life. Both functional endoscopic sinus surgery and dupilumab achieve comparable disease control and result in good symptom relief. Dupilumab is far more expensive than functional endoscopic sinus surgery and is not considered cost-effective for the time being. This is expected to change after 10 years when the drug patent expires. More research is needed to compare the complications of both treatment modalities.
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Affiliation(s)
- Asmaa Alshatti
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Christopher Webb
- Department of Otorhinolaryngology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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15
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Chong AXJ, Alvarado R, Rimmer J, Campbell RG, Kalish L, Png LH, Harvey RJ. Comparison of Allergen Immunotherapy Alone and in Conjunction With Turbinate Surgery for Nasal Obstruction in Perennial Allergic Rhinitis Patients. Ann Otol Rhinol Laryngol 2024:34894241234593. [PMID: 38414187 DOI: 10.1177/00034894241234593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. METHODOLOGY/PRINCIPAL A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT-with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. RESULTS A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P = .048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P = .002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (-13.9 ± 110.3 L/minute vs -3.4 ± 78.1 L/minute, P = .049) and NAR (-0.120 ± 0.342 Pa/cm³/second vs -0.093 ± 0.224 Pa/cm³/second, P = .050). CONCLUSIONS Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone.
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Affiliation(s)
- Amaris Xin Jie Chong
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Woolcock Institute, University of Sydney, Sydney, Australia
- Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Raewyn G Campbell
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lu Hui Png
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Singapore General Hospital, Singapore, Singapore
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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16
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Ferri S, Montagna C, Casini M, Malvezzi L, Pirola F, Russo E, Racca F, Messina MR, Puggioni F, Nappi E, Costanzo G, Del Moro L, Mercante G, Spriano G, Canonica GW, Paoletti G, Heffler E. Sleep quality burden in chronic rhinosinusitis with nasal polyps and its modulation by dupilumab. Ann Allergy Asthma Immunol 2024; 132:69-75. [PMID: 37652235 DOI: 10.1016/j.anai.2023.08.594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a substantial burden on patients' quality of life and impaired sleep quality. The most common CRSwNP endotype is characterized by type 2 inflammation, with enhanced production of interleukin (IL)-4, IL-5, and IL-13. Dupilumab is a monoclonal antibody against IL-4 receptor-α, which inhibits both IL-4 and IL-13 signaling, and was recently approved for treatment of CRSwNP. OBJECTIVE We investigated the effect of dupilumab on the sleep quality of patients with CRSwNP in a real-life setting. METHODS Patients were evaluated at baseline and after 1 and 3 months of dupilumab treatment by means of the Epworth sleepiness scale (ESS), insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), and sinonasal outcome test 22 (SNOT-22) sleep domain. RESULTS A total of 29 consecutive patients were enrolled, and their baseline sleep quality assessment were as follows: ESS of 7.9 (± 4.5); ISI of 13.1 (± 6.2); PSQI of 9.2 (± 3.7); and SNOT-22 sleep domain of 12.1 (± 4.2). Excessive daily sleepiness, insomnia, and globally impaired sleep quality were present in 24.1%, 79.3%, and 93.1% respectively. Treatment with dupilumab was associated with significant improvement in ESS, ISI, PSQI, and SNOT-22 sleep domain with concomitant reduction of the proportion of patients with insomnia and globally impaired sleep quality. CONCLUSION CRSwNP was associated with a significant impact on global sleep quality, in particular, insomnia, and treatment with dupilumab induced a rapid improvement (after 1 single month of treatment) in all the sleep quality parameters, suggesting that sleep disturbances should be more carefully evaluated as an additional outcome in these patients.
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Affiliation(s)
- Sebastian Ferri
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo Montagna
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Casini
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology, Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Pirola
- Otorhinolaryngology, Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Russo
- Otorhinolaryngology, Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Rita Messina
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Emanuele Nappi
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Costanzo
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lorenzo Del Moro
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology, Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology, Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma, and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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17
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Hentati F, Kim J, Hoying D, D'Anza B, Rodriguez K. Race and Area of Deprivation Index Predict Outcomes of Endoscopic Sinus Surgery for Chronic Sinusitis. Am J Rhinol Allergy 2024; 38:6-13. [PMID: 37796754 DOI: 10.1177/19458924231204129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The purpose of this study is to characterize the presentation, outcomes, and barriers to care for White and non-White patients undergoing endoscopic sinus surgery (ESS). BACKGROUND ESS is often successful in providing long-term relief for patients suffering from chronic rhinosinusitis (CRS). Literature that uses robust measures of socioeconomic status (SES) and barriers to care to assess ESS outcomes is limited. METHODS A retrospective matched cohort study of patients who underwent ESS for CRS between 1/1/2015 and 6/1/2021 at a single tertiary care academic center was conducted. White and non-White patients were matched 1-to-1 by sex and age (± 5 years). SES was evaluated using the area of deprivation index (ADI). RESULTS Of the 298 patients included in the study, 149 are White and 149 are non-White, 111 (37.2%) have CRS with nasal polyposis (CRSwNP), 141 (47.3%) had allergic rhinitis, 90 (30.2%) had asthma and 22 (7.4%) required revision ESS. Non-White patients were 3.62 times more likely to present with CRSwNP (95% confidence interval [CI] 2.2-5.96) and had 2.87 times increased odds for requiring revision ESS than age and sex-matched White patients (95% CI 1.090-7.545). The median ADI for non-White (6.00) patients was higher than for White patients (3.00) (P < .001) and 21.5% more non-White patients presented with Medicaid (P < .001). CONCLUSION Non-White patients undergoing ESS for CRS are more likely to present from areas with fewer resources and be underinsured. Using robust measures of SES, such as ADI, may allow for care to be tailored to patients with barriers to care.
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Affiliation(s)
- Firas Hentati
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jaehee Kim
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian D'Anza
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Prajwal Gowda PR, Bai JS, Naik SM, Abhilasha S. Evaluation of Improvement in Chronic Rhinosinusitis After Endoscopic Sinus Surgery Using Sino-Nasal Outcome Test-22 (SNOT22) Symptom Score. Indian J Otolaryngol Head Neck Surg 2023; 75:3337-3343. [PMID: 37974715 PMCID: PMC10646061 DOI: 10.1007/s12070-023-03929-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 11/19/2023] Open
Abstract
Sino-Nasal Outcome Test (SNOT-22) symptom score is the most widely used questionnaire due to its easy interpretation with respect to quality of life (QOL) in patients with chronic rhinosinusitis (CRS). It helps in deciding further treatment plan in patients with refractory CRS despite maximal medical therapy (MMT). Endoscopic sinus surgery (ESS) is suggested in patients not responding to medical treatment. The preoperative and post-operative QOL for patients with CRS is assessed using SNOT-22. To assess SNOT-22 score change in CRS resistant to MMT. This is a longitudinal study conducted from April 2021-September 2022 included patients diagnosed to have CRS, satisfying the inclusion criteria. SNOT-22 for symptom severity assessed at the first visit, 1 week and 12 weeks and after MMT. Patients who failed MMT, posted for ESS. Post-operatively SNOT-22 symptom score re-assessed at 15 days, 1 month, 2 months and 3 months. 56 patients (male-51% and female-49%) who failed to respond to MMT included in the study. The five major troublesome symptoms nasal blockage (92.86%), need to blow nose (75%), facial pressure/pain (53.57%), post nasal discharge (51.79%), and sneezing (42.86%). The mean SNOT-22 symptom score when compared with pre-operatively (69.54 ± 8.973) and after FESS (2.09 ± 1.881) had improved significantly (p < 0.001). CRS is more frequently seen in males aged between 21 and 30 years. The patient-based outcome measures, like SNOT-22 helps to foresee the extent of post- operative improvement. The effective management of CRS is by surgical intervention.
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Affiliation(s)
| | - J. Sarah Bai
- Department of Otorhinolaryngology, The Oxford Medical College, Hospital and RC, Yadavanahalli, Bangalore, Karnataka India
| | - Sudhir M. Naik
- Department of Otorhinolaryngology, The Oxford Medical College, Hospital and RC, Yadavanahalli, Bangalore, Karnataka India
| | - Somashekar Abhilasha
- Department of Otorhinolaryngology, The Oxford Medical College, Hospital and RC, Yadavanahalli, Bangalore, Karnataka India
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Hentati F, Kim J, Hoying D, D'Anza B, Rodriguez K. Revision Rates and Symptom Trends Following Endoscopic Sinus Surgery: Impact of Race on Outcomes. Laryngoscope 2023; 133:2878-2884. [PMID: 36971208 DOI: 10.1002/lary.30647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the impact of demographics and sinonasal comorbidities on the revision rate of functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). BACKGROUND Although endoscopic sinus surgery (ESS) is often successful in providing long-term relief for patients suffering from CRS, revision surgery can occur. There is conflicting literature on the impact of race on FESS outcomes. METHODS A single-center retrospective cohort study of patients that underwent FESS for CRS between January 1, 2015 and June 1, 2021 at a single tertiary care academic center. RESULTS A total of 682 patients between the ages of 18 and 89 underwent primary ESS between January 1, 2015 and June 1, 2021 and were included in this study. Of these patients, 388 (56.9%) were female, with an average age of 48.6 ± 16.7. Thirty-eight patients (5.6%) underwent revision sinus surgery during the study period. Patients that identified as White had significantly lower rates of revision sinus surgery (4.1%) than non-White patients (10.7%), including those identifying as Asian, Black, multiracial, or other. On multivariate analysis, non-White race (OR 4.933), polyposis (3.175), and high preoperative SNOT-22 scores (OR 1.029) were independently associated with revision sinus surgery. The mean preoperative SNOT-22 for all participants was 39.1 ± 22.0, whereas the mean postoperative SNOT-22 was 20.6 ± 17.5 (p < 0.001). CONCLUSION Race plays an important role in outcomes following revision sinus surgery that is independent of location and insurance status. More studies are required to assess the reason race plays an important role in outcomes following revision sinus surgery. LEVEL OF EVIDENCE Level 3 Laryngoscope, 133:2878-2884, 2023.
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Affiliation(s)
- Firas Hentati
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Jaehee Kim
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Brian D'Anza
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Kenneth Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
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Laidlaw TM, Menzies-Gow A, Caveney S, Han JK, Martin N, Israel E, Lee JK, Llanos JP, Martin N, Megally A, Parikh B, Vong S, Welte T, Corren J. Tezepelumab Efficacy in Patients with Severe, Uncontrolled Asthma with Comorbid Nasal Polyps in NAVIGATOR. J Asthma Allergy 2023; 16:915-932. [PMID: 37692126 PMCID: PMC10488831 DOI: 10.2147/jaa.s413064] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Tezepelumab, a human monoclonal antibody, blocks thymic stromal lymphopoietin. In the phase 3 NAVIGATOR study (NCT03347279), tezepelumab reduced annualized asthma exacerbation rates (AAERs) versus placebo, irrespective of baseline disease characteristics, and improved lung function and symptom control versus placebo in adults and adolescents with severe, uncontrolled asthma. We assessed the efficacy of tezepelumab in patients with severe asthma with or without nasal polyps (NPs) in the 2 years before randomization in NAVIGATOR. Methods Patients with severe asthma (N=1059) were randomized (1:1) and received tezepelumab 210 mg or placebo every 4 weeks subcutaneously for 52 weeks. Prespecified exploratory analyses included: AAER over 52 weeks and changes from baseline to week 52 in pre-bronchodilator forced expiratory volume in 1 second, Sino-Nasal Outcome Test (SNOT)-22 scores, and asthma control and health-related quality life (HRQoL) outcomes in NP subgroups. Changes from baseline in fractional exhaled nitric oxide (FeNO), blood eosinophil counts, total immunoglobulin E (IgE), eosinophil-derived neurotoxin (EDN), matrix metalloproteinase-10 (MMP-10), and serum interleukin (IL)-5, IL-6, IL-8 and IL-13 were assessed (post hoc). Results Tezepelumab reduced the AAER over 52 weeks versus placebo by 85% (95% confidence interval [CI]: 72, 92; n=118) and 51% (95% CI: 40, 60; n=941) in patients with and without NPs, respectively. At week 52, tezepelumab improved lung function, asthma control and HRQoL versus placebo in patients with and without NPs. Tezepelumab reduced SNOT-22 total scores (least-squares mean difference versus placebo [95% CI]) in patients with NPs at 28 weeks (-12.57 points [-19.40, -5.73]) and 52 weeks (-10.58 points [-17.75, -3.41]). At week 52, tezepelumab reduced blood eosinophil counts and FeNO, IgE, IL-5, IL-13, EDN and MMP-10 levels versus placebo, irrespective of NP status. Conclusion Tezepelumab resulted in clinically meaningful improvements in sino-nasal symptoms and asthma outcomes in patients with severe asthma with comorbid NPs.
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Affiliation(s)
- Tanya M Laidlaw
- Jeff and Penny Vinik Center for Allergic Diseases Research, Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew Menzies-Gow
- Royal Brompton and Harefield Hospitals, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Scott Caveney
- Global Development, Inflammation, R&D, Amgen, Thousand Oaks, CA, USA
| | - Joseph K Han
- Department of Otolaryngology, Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Nicole Martin
- Biometrics, Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
- Cytel Inc, Waltham, MA, USA
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason K Lee
- Evidence Based Medical Educator Inc., Toronto, ON, Canada
- Toronto Allergy and Asthma Clinic, Toronto, ON, Canada
| | | | - Neil Martin
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
- University of Leicester, Leicester, UK
| | - Ayman Megally
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Bhavini Parikh
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Sylvia Vong
- Translational Science and Experimental Medicine, Early Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Tobias Welte
- Department of Respiratory Medicine and German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Jonathan Corren
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Fu Y, Liu D, Huang W, Wang Z, Zhang Y. A Systematic Review and Meta-analysis of SNOT-22 Outcomes After Sinus Surgery. EAR, NOSE & THROAT JOURNAL 2023:1455613231187761. [PMID: 37606061 DOI: 10.1177/01455613231187761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Background: All stakeholders in the healthcare system have prioritized and will continue to prioritize enhancing care quality. The measurement of sinus-specific quality of life (QOL) is potentially the most commonly used QOL parameter for chronic rhinosinusitis (CRS). Objective: A systematic review and meta-analysis were used in this study to determine the mean change in patients' scores on the 22-item Sino-Nasal Outcome Test (SNOT-22) before and after endoscopic sinus surgery (ESS) for CRS. Methods: PubMed, Google Scholar, and ScienceDirect were searched for articles that compared SNOT-22 scores before and after ESS in adult patients with CRS and were published between January 2000 and March 2023. The mean post-op change, 95% confidence interval (CI), forest plot, and inverse variance weighting were all generated using a random effects model. A mixed-effects meta-regression was used to analyze the effect of patient-specific characteristics across studies. Results: Fifteen prospective patient cohorts published from 2009 to 2023 were included in this meta-analysis. At an average follow-up of 25.5 months, all studies demonstrated a statistically significant difference in mean SNOT-22 scores between baseline and post-op time periods (P < .05), ranging from 5.1 to 55.4. Across all studies, the mean SNOT-22 changed significantly by 26.02 (95% CI: 12.83-38.60). According to a stepwise multivariate analysis, studies with higher mean age and mean pre-op SNOT-22 scores had greater changes in SNOT-22 scores following ESS, whereas trials with longer mean follow-up duration had smaller changes in SNOT-22 scores. Conclusion: Research utilizing the SNOT-22 instrument has demonstrated that endoscopic sinus surgery (ESS) leads to enhanced quality of life (QOL) outcomes. The literature reports that improvement is influenced by the initial SNOT-22 score, the mean age of the patients, and the duration of the follow-up period.
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Affiliation(s)
- Yangyang Fu
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Delong Liu
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Weipeng Huang
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Zhengying Wang
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
| | - Yue Zhang
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Dalian University of Technology, Dalian Liaoning, China
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22
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Wu CN, Wang YM, Chen WC, Fang FM, Li SH, Huang TL, Hwang CF, Lee Y, Lin CY, Luo SD. Evaluation of Sinonasal Outcome Test (SNOT-22) Domains in the Assessment of the Quality of Life in Patients with Nasopharyngeal Carcinoma. Cancer Manag Res 2023; 15:719-728. [PMID: 37485039 PMCID: PMC10362877 DOI: 10.2147/cmar.s416353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023] Open
Abstract
Background Few instruments are available for assessing the otorhinologic-related quality of life (QOL) in nasopharyngeal carcinoma (NPC) patients. Therefore, we evaluated whether the 22-item Sinonasal Outcome Test (SNOT-22) could be applied to these patients. Methods Patients diagnosed with NPC, who had been treated with standard protocol and followed up in our institute between 2019 and 2022, were invited to join the cross-sectional study during their clinic visits. All participants completed the SNOT-22 and Eustachian Tube Dysfunction Questionnaire-7 once they were recruited. Confirmatory factor analysis (CFA) was performed to decide the most suitable model for the underlying SNOT-22 subdomains, along with various validity and reliability tests. Results We identified a total of 275 patients, with 84 (30.5%) women and 191 (69.5%) men. The mean age was 54.1 years (standard deviation: 11.2). Among these patients, 171 (62.1%) were in late stages, and 260 (94.5%) received chemoradiotherapy as treatment. The median interval between primary RT treatment and questionnaire completion was 50 months (interquartile range: 29-93). CFA supported a five-factor model for the SNOT-22 for NPC patients, including nasal, ear/facial, sleep, function, and emotion domains. The internal consistency and test-retest reliability of the SNOT-22 domain score were good. In addition, known-group validity was good for the SNOT-22 total score and domain scores according to the disease recurrence status. Conclusion Psychometric analyses supported the reliability and validity of a five-domain SNOT-22 for assessing otorhinologic-related QOL in NPC patients.
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Affiliation(s)
- Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tai-Lin Huang
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Feng Hwang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung, Taiwan
| | - Chung-Ying Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taoyuan, 33302, Taiwan
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23
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Maspero JF, Khan AH, Philpott C, Hellings PW, Hopkins C, Wagenmann M, Siddiqui S, Msihid J, Nash S, Chuang CC, Kamat S, Rowe PJ, Deniz Y, Jacob-Nara JA. Health-Related Quality of Life Impairment Among Patients with Severe Chronic Rhinosinusitis with Nasal Polyps in the SINUS-24 Trial. J Asthma Allergy 2023; 16:323-332. [PMID: 37016622 PMCID: PMC10066887 DOI: 10.2147/jaa.s372598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease with a high symptom burden. Data are lacking on the comparative health status of patients with CRSwNP. This analysis compared baseline physical and mental health-related quality of life (HRQoL) and overall health status of patients with severe CRSwNP enrolled in a Phase 3 clinical trial with general population norms and with other chronic diseases. Methods In this post hoc cross-sectional analysis of baseline data from the SINUS-24 study (NCT02912468), HRQoL was measured using the 36-item Short Form (SF-36) questionnaire and general health status was measured using the EuroQol-5 Dimension visual analog scale (EQ-VAS). Analyses included the intention-to-treat (ITT) population and subgroups defined by prior sinonasal surgery, systemic corticosteroid use, and coexisting asthma or non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD). Scores were compared with published values for population norms (50 for SF-36 physical component summary (PCS) and mental component summary (MCS), 70.4-83.3 for EQ-VAS) and for rheumatoid arthritis, type 2 diabetes, and asthma. Results In the ITT population (n=276), mean SF-36 physical component summary (PCS), SF-36 mental component summary (MCS), and EQ-VAS scores were below general population norms (46.4, 48.6, and 66.0, respectively). Mean SF-36 PCS and EQ-VAS scores were below population norms across all subgroups; mean SF-36 MCS scores were below the population norm in all subgroups except no prior surgery. SF-36 PCS and MCS scores from SINUS-24 were generally similar to other chronic diseases, except SF-36 PCS which was lower in rheumatoid arthritis. EQ-VAS scores in SINUS-24 were lower than in other chronic diseases. HRQoL scores weakly correlated with objective measures of disease severity. Conclusion In patients with severe CRSwNP, including those with coexisting asthma/NSAID-ERD, HRQoL was worse than population norms and as burdensome as diseases such as type 2 diabetes, asthma, and rheumatoid arthritis.
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Affiliation(s)
- Jorge F Maspero
- Allergy & Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
- Correspondence: Jorge F Maspero, Allergy & Respiratory Research Unit, Fundación CIDEA, Paraguay 2035, 2SS, Buenos Aires, Argentina, Tel +54 9 11 4183-7294, Email
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | - Carl Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter W Hellings
- Department of Otorhinolaryngology – Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Claire Hopkins
- Department of Otorhinolaryngology, King’s College London, London, UK
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Jérôme Msihid
- Health Economics and Value Assessment, Sanofi, Chilly-Mazarin, France
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Siddhesh Kamat
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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24
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Behnke J, Dundervill C, Bulbu M, Armeni M, Ramadan HH, Makary CA. Using the sino-nasal outcome test (SNOT-22) to study outcome of treatment of nasal obstruction. Am J Otolaryngol 2023; 44:103879. [PMID: 37004319 DOI: 10.1016/j.amjoto.2023.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To validate the sino-nasal outcome test (SNOT-22) as an outcome measure for nasal obstruction, and to determine if it correlates with the nasal obstruction and septoplasty effectiveness (NOSE) scale. STUDY DESIGN Prospective cohort study. METHODS All patients presenting to our otolaryngology clinic for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy between August 2020 and June 2022 were asked to fill both the SNOT-22 and the NOSE questionnaires. Demographics and comorbidities were reviewed. Patients with chronic rhinosinusitis (CRS) were excluded. SNOT-22 total and subdomain scores were then compared to NOSE scores. RESULTS 126 patients completed both surveys. Average age was 42.6 years (range 13.8-78.3 years), and 40.5 % were female. 35 patients had septoplasty and inferior turbinoplasty (IT), 34 had functional septorhinoplasty and IT, 6 patients had IT, 7 had nasal septal perforation repair and 44 patients had medical treatment. Overall, SNOT-22 and NOSE scores correlated well preoperatively and postoperatively (r = 0.54, p < 0.0001; r = 0.68, p < 0.0001 respectively). The rhinologic and sleep SNOT-22 subdomains scores had the strongest correlation to NOSE score (r = 0.56, p < 0.0001; r = 0.64, p < 0.0001 respectively). Both NOSE and SNOT-22 scores showed improvement postoperatively [NOSE: 67.4 vs 25.1 (p < 0.0001) at 3 months, 69.5 vs 34 (p < 0.0001) at 6 months; SNOT-22: 37.1 vs 25.2 (p = 0.002) at 3 months, 38.1 vs 22.6 (p = 0.002) at 6 months]. No significant improvement in NOSE or SNOT scores was seen in the medical treatment group. CONCLUSION SNOT-22 instrument can be used to study the outcome of treatment for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy. LEVEL OF EVIDENCE: 4
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25
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Pedersen CK, Haase C, Aanaes K, von Buchwald C, Backer V. An update on patient reported outcomes in type 2 inflammation airway disease. Curr Opin Allergy Clin Immunol 2023; 23:1-8. [PMID: 36378110 DOI: 10.1097/aci.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Patient reported outcome measures (PROMs) play an important role in assessing so-called global airway disease caused by type-2 inflammation, not only in terms of patients' perspective on symptoms and treatment/side-effect, but they can also serve as a measure of disease control, and not least as an indicator of possible coexisting comorbidity otherwise unrecognized. The objective of this review was to investigate any newly developed PROMs for global airway disease and to give an overview of the most commonly used PROMs in the management of global airway disease. RECENT FINDINGS The Standard Tests for Asthma, Allergic Rhinitis and Rhinosinusitis (STARR-15) is a recently developed PROM aimed to raise clinicians' awareness of coexisting type-2 inflammation disease. Strengths of the STARR-15 is that is quick and symptom-centered, i.e. items are not specifically aimed at a disease the patients might not be aware they have. The STARR-15 has, however, not yet been validated, so details of responsiveness and reproducibility are yet to be determined. SUMMARY PROMs are a quick and cheap way to assess patient perspectives in global airway disease, and can play an important role in unveiling otherwise overlooked co-existing double disease.
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Affiliation(s)
- Christian Korsgaard Pedersen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital Rigshospitalet, Denmark
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26
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Mitchell MB, Workman AD, Lee SE. Clinically meaningful changes in efficacy outcomes in chronic rhinosinusitis with nasal polyposis. Curr Opin Allergy Clin Immunol 2023; 23:9-13. [PMID: 36539378 DOI: 10.1097/aci.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis with nasal polyps (CRSwNP) carries a high disease burden, and many studies have been done investigating the efficacy of various medical and surgical therapies. However, outcome metrics have varied across these studies, making it difficult to compare therapeutic efficacy on a large scale. In this article, we discuss various outcome metrics used across prior studies as well as the relationship between these measures. RECENT FINDINGS Outcome metrics in CRSwNP studies include both clinically assessed and patient-reported outcome measures (PROMs). The former includes olfaction testing, scoring systems based on imaging and endoscopic evaluation, and histopathological and immunohistochemical evaluation of sinus tissue, and the latter includes quality-of-life instruments, symptom severity scales, and disease-control instruments. Recent studies evaluating the efficacy of new biologics have used a combination of both types of metrics. SUMMARY Both clinical metrics and patient-reported outcomes provide utility in evaluating disease severity and control in patients with CRSwNP, although there are nuances when comparing therapies in this population as patients with CRSwNP are heterogeneous and may have symptoms across several domains. However, PROMs in conjunction with clinical metrics provide useful information to assess patient symptoms and response to interventions.
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Affiliation(s)
- Margaret B Mitchell
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alan D Workman
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stella E Lee
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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27
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Busse WW, Pavord ID, Siddiqui S, Khan AH, Praestgaard A, Nash S, Jacob-Nara JA, Rowe PJ, Deniz Y. Dupilumab Improves Outcomes in Patients with Chronic Rhinosinusitis with Nasal Polyps and Coexisting Asthma Irrespective of Baseline Asthma Characteristics. J Asthma Allergy 2023; 16:411-419. [PMID: 37096015 PMCID: PMC10122472 DOI: 10.2147/jaa.s391896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
Purpose Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease frequently coexisting with other type 2 conditions including asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD). Coexisting asthma leads to increased CRSwNP symptom burden. Dupilumab, a monoclonal antibody that blocks the shared receptor component for interleukin-4 and -13, demonstrated efficacy in adults with severe CRSwNP in the Phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) studies, including in patients with coexisting asthma/NSAID-ERD. However, the impact of different asthma characteristics on dupilumab treatment in this population is unknown. We report CRSwNP and asthma outcomes with dupilumab in patients with CRSwNP and coexisting asthma according to baseline asthma characteristics. Methods Change from baseline at Week 24 (pooled studies) and Week 52 (SINUS-52) in CRSwNP outcomes (nasal polyp score, nasal congestion, 22-item Sino-Nasal Outcome Test [SNOT-22], loss of smell score, University of Pennsylvania Smell Identification Test) and asthma outcomes (5-item Asthma Control Questionnaire [ACQ-5], pre-bronchodilator forced expiratory volume in 1 second [FEV1]) were analyzed post hoc for placebo and dupilumab 300 mg every 2 weeks according to baseline blood eosinophils ≥150/≥300 cells/µL, ACQ-5 scores <1.5/≥1.5, and FEV1 <80%. Results In the pooled studies, 428/724 patients (59.1%) had coexisting asthma, of which 181/428 (42.3%) had coexisting NSAID-ERD. Dupilumab significantly improved all CRSwNP and asthma outcomes vs placebo at Week 24 (P < 0.001) regardless of baseline eosinophil or ACQ-5 category, or FEV1 <80%. Similar magnitude of improvement was seen at Week 52 (SINUS-52) and in patients with NSAID-ERD (pooled studies, Week 24). By Week 24, improvements with dupilumab exceeded the minimum clinically important differences for ACQ-5 and SNOT-22 in 35.2% to 74.2% and 72.0% to 78.7% of patients, respectively. Conclusion Dupilumab improved CRSwNP outcomes in patients with CRSwNP and coexisting asthma, and improved asthma outcomes, regardless of differences in baseline asthma characteristics.
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Affiliation(s)
- William Walter Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin, Madison, WI, USA
- Correspondence: William Walter Busse, Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin, Madison, WI, USA, Tel +1 608 263-6183, Email
| | - Ian Douglas Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | | | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | | | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Otorhinolaryngology Symptom Assessment Using SNOT 22 Among SARS CoV-2 Patients in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2022; 75:793-799. [PMID: 36571091 PMCID: PMC9760531 DOI: 10.1007/s12070-022-03340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
The main aim of the study was to assess various ENT symptoms in COVID 19 patients, also to investigate the severity of ENT symptoms among COVID 19 patients and find their relation on basis of scores among five discrete domains of SNOT 22 (Sino nasal Outcome Test). A prospective observational study was conducted among 135 patients between 18 to 75 years of age, in the month of September 2020 with COVID-19 infection having mild, moderate disease who were admitted to our hospital. Subjects were divided into groups according to their presenting ENT symptoms based on age, gender and other comorbidities and differences between the groups were examined. The sinonasal symptoms were assessed using the SNOT 22 questionnaire. A strong statistical significance with loss of smell and taste sensation was noted in patients above the age of 40 years. It was also noted that the patients who presented with cough above the age of 40 years were significantly more. Evaluation of sinonasal symptoms using SNOT 22 questionnaire showed that Extranasal rhinologic symptoms, Psychological dysfunction, Sleep dysfunction had significantly higher association among patients who were more than 40 years. We observed that, Extranasal rhinologic symptoms were significantly higher among males than females. There is thus an emergent need to develop a uniform tool to assess the various ENT symptoms. In our study we assessed the patients with COVID 19 using a standard questionnaire to observe the symptomatology, psychological and sleep dysfunctions due to sinonasal issues, and to closely understand the relationship of various symptoms in a meticulous manner.
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Lin JS, Tan B, Yeh C, Kern R, Conley D, Welch K, Peters A, Smith S. Comparing the severity of chronic rhinosinusitis symptoms before versus during the COVID-19 pandemic. Laryngoscope Investig Otolaryngol 2022; 7:1704-1711. [PMID: 36544956 PMCID: PMC9764742 DOI: 10.1002/lio2.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 measures such as masking, social distancing, and staying indoors may mitigate chronic rhinosinusitis (CRS) symptoms. We evaluate whether these measures correlated with improved symptoms in patients with CRS. Methods This retrospective study compared SNOT-22 survey data from the Northwestern CRS Registry at the time of enrollment and at years 1-5 of follow-up. The final sample consisted of 1826 SNOT-22 surveys for 598 patients. April 10, 2020 to December 31, 2021 was considered "during the pandemic" and prior to March 11, 2020 was considered "pre-pandemic." Wilcoxon test was used to compare SNOT22 at enrollment pre-pandemic versus during pandemic. Separate linear mixed models were performed to estimate SNOT22 at 1 to 5 years after enrollment pre-pandemic versus during pandemic. Results Subjects enrolled during the pandemic had worse SNOT22 scores than those enrolled pre-pandemic (53 vs. 42, p = .0024). Total SNOT-22 scores were improved during the pandemic than before the pandemic at 1 year follow-up (18.17 vs. 12.22, p = .001). This effect persists when evaluating the nasal (7.33 vs. 5.13, p = .003), sleep (2.63 vs. 1.39, p = .008), function (1.40 vs. 0.72, p = .015), and emotion (0.77 vs. 0.17, p < .001) domains individually. There was no statistically significant difference in total SNOT-22 score at Years 2-5 of follow-up. Conclusions Patients with CRS experience a greater reduction in symptom severity in their first year of treatment during the pandemic than before the pandemic, plausibly from measures such as masking and staying indoors. Level of Evidence 4.
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Affiliation(s)
- Jasmine S. Lin
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Bruce Tan
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventative MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Robert Kern
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - David Conley
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Kevin Welch
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Anju Peters
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Stephanie Smith
- Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Busse WW, Wellman A, Diamant Z, Cohen NA, Chaker AM, Bachert C, Siddiqui S, Zhang H, Nash S, Khan AH, Jacob-Nara JA, Rowe PJ, Deniz Y. Impact of dupilumab on SNOT-22 sleep and function scores in CRSwNP. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2479-2482.e3. [PMID: 35618213 DOI: 10.1016/j.jaip.2022.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- William W Busse
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology, Lund University, Lund, Sweden; Department of Microbiology, Immunology & Transplantation, Catholic University Leuven, Leuven, Belgium
| | - Noam A Cohen
- Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Adam M Chaker
- Department of Otolaryngology and ZAUM, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden; The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Haixin Zhang
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | | | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, NJ
| | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Lee SE, Hopkins C, Mullol J, Msihid J, Guillemin I, Amin N, Mannent LP, Li Y, Siddiqui S, Chuang C, Kamat S, Khan AH. Dupilumab improves health related quality of life: Results from the phase 3 SINUS studies. Allergy 2022; 77:2211-2221. [PMID: 35034364 PMCID: PMC9305228 DOI: 10.1111/all.15222] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/26/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2-mediated inflammatory disease with high symptom burden and reduced health-related quality of life (HRQoL). This report aimed to comprehensively understand the effects of dupilumab on domains of HRQoL, their individual elements, and health status in patients with severe CRSwNP from phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) trials. METHODS Patients were randomized to dupilumab (n = 438) or placebo (n = 286) for 24 weeks (SINUS-24), or 52 weeks (SINUS-52). Disease-specific HRQoL using 22-item sino-nasal outcome test (SNOT-22), and health status using EuroQoL-visual analog scale (EQ-VAS) was evaluated in the pooled intention-to-treat (ITT) population (Week 24), SINUS-52 ITT (Week 52) and in the subgroups with/without asthma; non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD); and prior sinus surgery. RESULTS At baseline, patients had poor disease-specific HRQoL and general health status and identified "Decreased sense of smell/taste" and "Nasal blockage" as the most important symptoms. Dupilumab significantly improved SNOT-22 total, domain (Nasal, Sleep, Function, Emotion, and Ear/facial), and 22-item scores, and EQ-VAS, at Week 24 vs placebo (all p < .0001), with continued improvements to Week 52 in SINUS-52. Improvements occurred irrespective of comorbid asthma, NSAID-ERD, or prior surgery. A significantly greater proportion of dupilumab-treated patients exceeded clinically meaningful thresholds for SNOT-22 total score and EQ-VAS vs placebo (all subgroups p < .05 except patients without surgery at Week 24). CONCLUSIONS Dupilumab treatment led to significant clinically meaningful improvements across all aspects of disease-specific HRQoL, and general health status in patients with severe CRSwNP.
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Affiliation(s)
- Stella E. Lee
- Division of Otolaryngology—Head & Neck SurgeryBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Claire Hopkins
- ENT DepartmentGuy's and St Thomas' HospitalsKing's College LondonLondonUK
| | - Joaquim Mullol
- Hospital ClínicIDIBAPSUniversitat de BarcelonaCIBERESBarcelonaSpain
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, IncTarrytownNew YorkUSA
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Hopkins C, Buchheit KM, Heffler E, Cohen NA, Olze H, Khan AH, Msihid J, Siddiqui S, Nash S, Jacob-Nara JA, Rowe PJ, Deniz Y. Improvement in Health-Related Quality of Life with Dupilumab in Patients with Moderate-to-Severe Asthma with Comorbid Chronic Rhinosinusitis with/without Nasal Polyps: An Analysis of the QUEST Study. J Asthma Allergy 2022; 15:767-773. [PMID: 35698581 PMCID: PMC9188334 DOI: 10.2147/jaa.s363527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
Patients with asthma frequently have comorbid chronic rhinosinusitis (CRS) with or without nasal polyps, increasing disease burden and complicating treatment. These post hoc analyses investigated disease-specific health-related quality of life (HRQoL) and general health status in the randomized, placebo-controlled QUEST study (NCT02414854) in patients treated with dupilumab for moderate-to-severe asthma with comorbid CRS. Patients received 300 mg of dupilumab or placebo every 2 weeks for 52 weeks. CRS HRQoL was assessed by the 22-item Sino-Nasal Outcome Test (SNOT-22; items scored 0-5). The 22 items are categorized into 5 domains (nasal, ear/facial, sleep, function, and emotion), and patients report the top 5 most important items affecting their health. General health status was assessed by Euro-QoL visual analog scale (EQ-VAS). Of 1902 patients, 382 (20.1%) self-reported comorbid CRS; 193 patients receiving dupilumab 300 mg q2w or matched placebo were included in this analysis. At baseline, the most impacted SNOT-22 domain was nasal, and general health status was below population norms. Patients rated "decreased sense of taste/smell," "nasal blockage," "cough," "reduced productivity," and "wake up tired" as the 5 most important SNOT-22 items affecting their health. Percentage change from baseline in SNOT-22 total score was significantly greater for dupilumab vs placebo at Weeks 24, 36, and 52 (all p < 0.05). Improvements from baseline were significantly greater for dupilumab vs placebo at Week 52 for all SNOT-22 domains (p < 0.05), except emotion. At Week 52, significant changes from baseline with dupilumab vs placebo were observed for all 5 most important SNOT-22 items affecting their health (all p < 0.05). EQ-VAS was significantly improved with dupilumab vs placebo by Week 12, with improvements sustained to Week 52 (all p < 0.01). In patients with moderate-to-severe asthma who self-reported comorbid CRS, dupilumab treatment vs placebo improved CRS-specific HRQoL and general health status.
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Affiliation(s)
- Claire Hopkins
- Department of Otorhinolaryngology – Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Noam A Cohen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | - Jérôme Msihid
- Health Economics and Value Assessment, Sanofi, Chilly-Mazarin, France
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Konsur E, Rigg L, Moore D, Patel M, Batra PS, Mahdavinia M. Race and ethnicity define disparate clinical outcomes in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2022; 129:737-741. [PMID: 35623587 DOI: 10.1016/j.anai.2022.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common upper airways inflammatory disease requiring multidisciplinary care. OBJECTIVE To evaluate if African Americans (AA), Latinxs, and nonLatinx White (White) patients have different chronic rhinosinusitis outcomes and to identify associated factors impacting these outcomes. METHODS We conducted a large prospective cohort study of CRS patients who were evaluated and followed for several clinical variables at the initial encounter and after continuous management of CRS for a mean of 40 months. The Sinonasal Outcome Test (SNOT-22) and Lund-MacKay scores were measured on initial visits, and SNOT-22 was repeated at the end of follow-up. Logistic regression was used to compare outcomes between the different groups adjusted for comorbidities and demographics. RESULTS Among the 977 enrolled CRS cases, 615 (63.0%), 235 (24.1%) and 138 (13.0%) were White, AA and Latinx respectively. There was no difference in severity of CRS based on Lund-MacKay scores and SNOT-22 scores, and frequency of other comorbidities at presentation among the 3 groups. During the follow-up period, compared with Whites, AA and Latinx were less frequently evaluated by an allergist. AAs had less frequent CRS related visits and lower final SNOT-22 score compared with Whites. CONCLUSION Although our enrolled patients from the 3 ethnic groups had similar clinical characteristics and disease burden at baseline, AAs had less frequent follow-up visits and worse final SNOT-22 after 40 months of follow-up. The observed poorer outcomes in AAs are likely owing to inequity in healthcare access evidenced by differences in insurance and suboptimal management of CRS.
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Affiliation(s)
- Evelyn Konsur
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
| | - Lauren Rigg
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Donyea Moore
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Malina Patel
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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Heffernan A, Phulka J, Thamboo A. Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era. J Otolaryngol Head Neck Surg 2022; 51:22. [PMID: 35606866 PMCID: PMC9128111 DOI: 10.1186/s40463-022-00580-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is an inflammatory disease that may require biological therapy. Omalizumab is an anti-IgE biologic that was recently approved by the FDA and Health Canada for use in severe CRS with nasal polyps (CRSwNP) recalcitrant to intranasal corticosteroids. Dosing is based on weight and pre-treatment serum IgE, with elevated levels of the latter being an indication for biologic treatment according to EPOS and EUFOREA guidelines. The goal of this study was to identify variables that predict IgE-high type 2 inflammation and serve as indicators for biologic treatment in CRS. METHODS Patients ≥ 19 yo diagnosed with CRS undergoing functional endoscopic sinus surgery were included retrospectively. Demographics, past medical history, preoperative blood work, Lund-Mackay (LM), Lund Kennedy (LK), and SNOT-22 scores were extracted. Descriptive statistics and binary logistic regression analyses were conducted. Model superiority was based on Nagelkerke R2 scores and receiver operating characteristic curves. RESULTS Sixty-five patients, average age 49.96 ± 13.59 years, were included. Sixty-one binary logistic regression models for elevated serum IgE were created. Among the top 3 models, the best model had sensitivity, specificity, positive predictive value and negative predictive values of 82.1, 69.2, 80.0, and 72.0. All performance measures except sensitivity exceeded the Canadian Biologics Guideline model. Serum eosinophils ≥ 300 cell/uL, CRSwNP and LM ≥ 17 increased the odds of elevated IgE. CONCLUSIONS IgE-high type-2 inflammation can be predicted by a model that includes eosinophil ≥ 300 cell/uL, CRSwNP, LM ≥ 17, asthma diagnosis and SNOT-22 ≥ 40. Patients meeting these parameters have a high pretest probability for elevated IgE and would benefit from IgE serology to determine qualification for omalizumab. This could reduce unwarranted IgE serology in patients with CRSwNP but also target a patient population for further workup that will lead to optimization of resource allocation and improve healthcare equity in rural and remote areas within Canada.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Jobanjit Phulka
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada.
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, BC, Canada.
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