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Anselmo-Lima WT, Romano FR, Tamashiro E, Roithmann R, Dinarte VRP, Piltcher OB, Miyake MM, Fornazieri MA, Nakanishi M, Bezerra TFP, Dolci RLL, Mello JF, Lessa MM, Voegels RL, Kosugi EM, Sakano E, Valera FCP. Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update. Braz J Otorhinolaryngol 2024; 90:101394. [PMID: 38367543 PMCID: PMC10879704 DOI: 10.1016/j.bjorl.2024.101394] [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: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. OBJECTIVES The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. RESULTS We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient's life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. CONCLUSIONS This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
| | - Fabrizio R Romano
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | | | | | - Otavio B Piltcher
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (FAMED-UFRGS), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil; Santa Casa de Misericórdia, Hospital de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco A Fornazieri
- Universidade Estatual de Londrina, Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUCPR), Câmpus Londrina, Londrina, PR, Brazil
| | - Marcio Nakanishi
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação, Brasilia, DF, Brazil
| | | | | | - João F Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcus M Lessa
- Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Richard L Voegels
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo M Kosugi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eulalia Sakano
- Universidade Estadual Paulista, Faculdade de Ciências Médicas, Departamento de Oftalmologia/Otorrinolaringologia, Campinas, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Geng X, Xue J, Zheng H, Suo L, Zeng H, Zhao M, Song S, Liu Y, Zhao C, Yang P. The association between CD46 expression in B cells and the pathogenesis of airway allergy. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166845. [PMID: 37579982 DOI: 10.1016/j.bbadis.2023.166845] [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: 05/09/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
CD46 can facilitate the production of IgE. Activation of CD46 may contribute to the pathogenesis of allergic diseases. The aim of this study is to elucidate the association between CD46 expression in B cells and the pathogenesis of airway allergy. In this study, peripheral B cells were collected from a group of patients suffering from allergic rhinitis (AR). An AR mouse model was established to test the role of CD46 in the development of airway allergy. The results showed elevated amounts of IGE in peripheral CD46+ B cells of AR patients. CD46+ B cells of AR patients showed high reticulum endoplasmic (ER) stress status. The expression of CD46 in peripheral B cells was positively associated with the AR response in patients. The production of IgE in mice with airway allergy was prevented by ablating CD46 expression in B cells. Exposure to aluminum hydroxide up regulated the expression of Cd46 in B cells through exacerbating ER stress. Administration of Cd46 shRNA carrying nanoparticles attenuated experimental airway allergy. In conclusion, peripheral B cells in AR patients display elevated CD46 expression. Cd46 ablation in B cells can mitigate the production of IgE in mice and attenuate experimental airway allergy.
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Affiliation(s)
- Xiaorui Geng
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Jinmei Xue
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Haoyue Zheng
- Shenzhen Clinical School of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China; Institute of Allergy & Immunology of Shenzhen University, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen, China
| | - Limin Suo
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Haotao Zeng
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Miao Zhao
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Shuo Song
- Institute of Allergy & Immunology of Shenzhen University, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen, China; Department of General Practical Medicine, Third Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Yu Liu
- Institute of Allergy & Immunology of Shenzhen University, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen, China.
| | - Changqing Zhao
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China.
| | - Pingchang Yang
- Shenzhen Clinical School of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China.
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Papacharalampous GX, Constantinidis J, Fotiadis G, Zhang N, Bachert C, Katotomichelakis M. Chronic rhinosinusitis with nasal polyps (CRSwNP) treated with omalizumab, dupilumab, or mepolizumab: A systematic review of the current knowledge towards an attempt to compare agents' efficacy. Int Forum Allergy Rhinol 2024; 14:96-109. [PMID: 37394893 DOI: 10.1002/alr.23234] [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: 03/12/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The heterogeneity of existing studies, along with the fact that there are no published head-to-head trials, are the main reasons for the lack of guidelines regarding the selection of the proper biologic in treatment of chronic rhinosinusitis (CRS) with nasal polyps. The aim of this study is to summarize the current knowledge regarding the efficacy of omalizumab, dupilumab, and mepolizumab in CRS treatment. We also attempt to proceed to an indirect comparison of the agents and try to answer the tricky question: which agent to select and why? METHODS An extensive search in English literature was conducted in PubMed/Medline, Embase, Google Scholar, and Cochrane Database/Library. Eligibility criteria included papers with full text published in English, adult population studies, clearly described intervention protocol, and documented primary and secondary outcomes. RESULTS The studies included numbered 37. All agents provided significant improvement in polyp size, sinuses opacification, severity of symptoms, need for surgery and systemic corticosteroids use. Analysis of available systematic reviews, meta-analyses and indirect treatment comparison studies showed that dupilumab appeared to be the most beneficial agent, in terms of primary and secondary outcomes. However, these results are of relatively low level of evidence due to several methodological limitations. CONCLUSIONS Although the present analysis showed a moderate supremacy of dupilumab, there is still no evidence-based answer to the question "which biologic agent is the most effective in CRS treatment?" Improved statistical methodology, head-to-head trials, and real-life studies could lead to more robust conclusions, establishing the real role of the specific biologic agents.
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Affiliation(s)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Fotiadis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nan Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Michael Katotomichelakis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Palacios-García J, Porras-González C, Moreno-Luna R, Maza-Solano J, Polo-Padillo J, Muñoz-Bravo JL, Sánchez-Gómez S. Role of Fibroblasts in Chronic Inflammatory Signalling in Chronic Rhinosinusitis with Nasal Polyps-A Systematic Review. J Clin Med 2023; 12:jcm12093280. [PMID: 37176721 PMCID: PMC10179235 DOI: 10.3390/jcm12093280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease of the nose and paranasal sinuses characterized by the presence of nasal polyps. The symptoms produced by the presence of nasal polyps such as nasal obstruction, nasal discharge, facial pain, headache, and loss of smell cause a worsening in the quality of life of patients. The source of the nasal polyps remains unclear, although it seems to be due to a chronic inflammation process in the sinonasal mucosa. Fibroblasts, the main cells in connective tissue, are intimately involved in the inflammation processes of various diseases; to this end, we carried out a systematic review to evaluate their inflammatory role in nasal polyps. Thus, we evaluated the main cytokines produced by nasal polyp-derived fibroblasts (NPDF) to assess their involvement in the production of nasal polyps and their involvement in different inflammatory pathways. The results of the review highlight the inflammatory role of NPDF through the secretion of various cytokines involved in the T1, T2, and T3 inflammatory pathways, as well as the ability of NPDF to be stimulated by a multitude of substances. With these findings, the fibroblast is positioned as a new potential therapeutic target in the treatment of CRSwNP.
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Affiliation(s)
- José Palacios-García
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Virgen Macarena, Doctor Fedriani 3, 41009 Seville, Spain
| | - Cristina Porras-González
- Institute of Biomedicine of Seville (IBiS), Campus Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
- Department of Medical Biochemistry, Molecular Biology and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Doctor Fedriani 3, 41009 Seville, Spain
| | - Ramón Moreno-Luna
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Virgen Macarena, Doctor Fedriani 3, 41009 Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Campus Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Juan Maza-Solano
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Virgen Macarena, Doctor Fedriani 3, 41009 Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Campus Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Juan Polo-Padillo
- Department of Preventive Medicine and Public Health, University Hospital Virgen Macarena, Doctor Fedriani 3, 41009 Seville, Spain
| | - José Luis Muñoz-Bravo
- Clinical Analysis Service, General University Hospital of Elche, Foundation for the Promotion of Health and Biomedical Research in the Valencia Region (FISABIO), Av. De Catalunya 21, 46020 Valencia, Spain
| | - Serafín Sánchez-Gómez
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Virgen Macarena, Doctor Fedriani 3, 41009 Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Campus Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
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Mirza AA, Abdulazeem HM, Al-Sayed AA, Alandejani TA, Shawli HY, Thompson JY, Alhaddad MH, Varshney R, Zawawi F. Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:650-660. [PMID: 37206723 PMCID: PMC10188799 DOI: 10.1007/s12070-022-03144-8] [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: 09/01/2021] [Accepted: 08/19/2022] [Indexed: 05/21/2023] Open
Abstract
Objectives Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP. Data Source Systematic Review of three electronic databases. Review Methods Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs. Results A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported. Conclusion The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03144-8.
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Affiliation(s)
- Ahmad A. Mirza
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ahmed A. Al-Sayed
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Talal A. Alandejani
- Department of Surgery-Division of Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Surgery-Division of Otolaryngology, Ministry of the National Guard – Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Hatim Y. Shawli
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Jacqueline Y. Thompson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mohammed H. Alhaddad
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rickul Varshney
- Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada
| | - Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Tai J, Han M, Kim TH. Therapeutic Strategies of Biologics in Chronic Rhinosinusitis: Current Options and Future Targets. Int J Mol Sci 2022; 23:ijms23105523. [PMID: 35628333 PMCID: PMC9141505 DOI: 10.3390/ijms23105523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 12/25/2022] Open
Abstract
Chronic rhinosinusitis is a chronic inflammatory disease of the upper airways, for which treatment options include medical or surgical therapy. However, there are limitations to conservative treatment strategies, such as the relapse of nasal polyps. In this review, we discuss the rising role of biomolecular mechanisms associated with various biologics that have been approved or are undergoing clinical trials to treat chronic rhinosinusitis. We also highlight the potential molecular therapeutic targets for managing and treating chronic rhinosinusitis.
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Wu Q, Yuan L, Qiu H, Wang X, Huang X, Zheng R, Yang Q. Efficacy and safety of omalizumab in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2021; 11:e047344. [PMID: 34479933 PMCID: PMC8420736 DOI: 10.1136/bmjopen-2020-047344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the efficacy and safety of omalizumab for chronic rhinosinusitis with nasal polyps (CRSwNP) and to identify evidence gaps that will guide future research on omalizumab for CRSwNP. DESIGN Systematic review and meta-analysis. DATA SOURCES A comprehensive search was performed in PubMed, Embase, Web of Science and the Cochrane Library on 13 October 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) comparing omalizumab with placebo, given for at least 16 weeks in adult patients with CRSwNP. DATA EXTRACTION AND SYNTHESIS Two independent authors screened search results, extracted data and assessed studies using the Cochrane risk of bias tool. Data were pooled using the inverse-variance method and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed by the χ2 test and the I2 statistic. RESULTS A total of four RCTs involving 303 participants were identified. When comparing omalizumab to placebo, there was a significant difference in Nasal Polyps Score (MD=-1.20; 95% CI -1.48 to -0.92), Nasal Congestion Score (MD=-0.67; 95% CI -0.86 to -0.48), Sino-Nasal Outcome Test-22 (MD=-15.62; 95% CI -19.79 to -11.45), Total Nasal Symptom Score (MD=-1.84; 95% CI -2.43 to -1.25) and reduced need for surgery (risk ratio (RR)=5.61; 95% CI 1.99 to 15.81). Furthermore, there was no difference in the risk of serious adverse events ((RR=1.40; 95% CI 0.29 to 6.80), adverse events (RR=0.83; 95% CI 0.60 to 1.15) and rescue systemic corticosteroid (RR=0.52; 95% CI 0.17 to 1.61). CONCLUSIONS This was the first meta-analysis that identified omalizumab significantly improved endoscopic, clinical and patient-reported outcomes in adults with moderate to severe CRSwNP and it was safe and well tolerated. PROSPERO REGISTRATION NUMBER CRD42020207639.
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Affiliation(s)
- Qingwu Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lianxiong Yuan
- Department of Science and Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Huijun Qiu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xinyue Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xuekun Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Rui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Ranford D, Hopkins C. Safety review of current systemic treatments for severe chronic rhinosinusitis with nasal polyps and future directions. Expert Opin Drug Saf 2021; 20:1177-1189. [PMID: 33957840 DOI: 10.1080/14740338.2021.1926981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinosinusitis is a common condition characterized by inflammation of the nasal and sinus linings, rhinorrhea, nasal blockage, facial pain, and loss of sense of smell for longer than 12 weeks. CRS can occur with or without nasal polyps.Areas covered: First-line treatment in chronic rhinosinusitis with nasal polyps is long-term intranasal corticosteroids, which have few adverse events associated with their use, as second-generation intranasal corticosteroids having a bioavailability of <0.5%. Systemic corticosteroids are used when intranasal steroids fail to achieve symptom control. However, the repeated use of oral corticosteroids is associated with numerous adverse events and the benefit from a course of oral corticosteroids is lost within three to six months.Expert opinion: Antibiotics are commonly prescribed in nasal polyposis although there is also very little evidence for their use outside of acute infection. Macrolide antibiotics are also associated with a transient increase in the risk of arrhythmias. Biologics offer a steroid-sparing alternative to the treatment of severe nasal polyposis. They have shown to be relatively well tolerated in studies to date; however, studies suggest that there is no disease modifying effect and that any benefit is lost within weeks of finishing treatment.
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Affiliation(s)
- David Ranford
- ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK
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Anselmo-Lima WT, Tamashiro E, Romano FR, Miyake MM, Roithmann R, Kosugi EM, Nakanishi M, Fornazieri MA, Bezerra TFP, Mello JF, Lessa MM, Voegels RL, Piltcher OB, Sakano E, Valera FCP. Guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps (CRSwNP) in Brazil. Braz J Otorhinolaryngol 2021; 88:471-480. [PMID: 33867274 PMCID: PMC9422446 DOI: 10.1016/j.bjorl.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
The use of immunobiologicals is an option for the management of patients with chronic rinosinusitis with nasal polyps (CRSwNP) refractory to conventional treatment. The guideline lists the main drugs currently available in Brazil, their indications, and recommendations for use.
Introduction Severe uncontrolled chronic rhinosinusitis with nasal polyps has a negative impact on an individual’s quality of life. Therefore, new biologics have emerged for use in specific phenotypes of chronic rhinosinusitis, changing the paradigms of its treatment. Objective To review the current status of biologic treatment indications in chronic rhinosinusitis. Methods The Brazilian Academy of Rhinology brought together different specialists to suggest a course of action, considering its particularities and aspects related to the national reality. Results Of particular interest for decision making will be the identification of subgroups of patients refractory to pre-existing treatment options and the construction of a strategy that improves their quality of life, with the best cost-benefit ratio. Conclusion The use of biologics is a valid option for treatment in more severe cases. This strategy must be better understood and improved in the future, with more studies and greater clinical experience.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil
| | - Fabrizio R Romano
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil; Hospital da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | - Eduardo M Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | - Márcio Nakanishi
- Universidade de Brasília (UnB), Faculdade de Medicina, Brasilia, DF, Brazil
| | - Marco A Fornazieri
- Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brazil
| | | | - João F Mello
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Marcus M Lessa
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil
| | - Richard L Voegels
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Otávio B Piltcher
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (FAMED), Porto Alegre, RS, Brazil
| | - Eulalia Sakano
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil.
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Chong LY, Piromchai P, Sharp S, Snidvongs K, Webster KE, Philpott C, Hopkins C, Burton MJ. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev 2021; 3:CD013513. [PMID: 33710614 PMCID: PMC8094915 DOI: 10.1002/14651858.cd013513.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This living systematic review is one of several Cochrane Reviews evaluating the medical management of patients with chronic rhinosinusitis. Chronic rhinosinusitis is common. It is characterised by inflammation of the nasal and sinus linings, nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. It occurs with or without nasal polyps. 'Biologics' are medicinal products produced by a biological process. Monoclonal antibodies are one type, already evaluated in other inflammatory conditions (e.g. asthma and atopic dermatitis). OBJECTIVES To assess the effects of biologics for the treatment of chronic rhinosinusitis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; CENTRAL (2020, Issue 9); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 28 September 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) with at least three months follow-up comparing biologics (monoclonal antibodies) against placebo/no treatment in patients with chronic rhinosinusitis. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), disease severity and serious adverse events (SAEs). The secondary outcomes were avoidance of surgery, extent of disease (measured by endoscopic or computerised tomography (CT) score), generic HRQL and adverse effects (nasopharyngitis, including sore throat). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 10 studies. Of 1262 adult participants, 1260 had severe chronic rhinosinusitis with nasal polyps; 43% to 100% of participants also had asthma. Three biologics, with different targets, were evaluated: dupilumab, mepolizumab and omalizumab. All of the studies were sponsored or supported by industry. For this update (2021) we have included two new studies, including 265 participants, which reported data relating to omalizumab. Anti-IL-4Rα mAb (dupilumab) versus placebo/no treatment (all receiving intranasal steroids) Three studies (784 participants) evaluated dupilumab. Disease-specific HRQL was measured with the SNOT-22 (a 22-item questionnaire, with a score range of 0 to 110; minimal clinically important difference (MCID) 8.9 points). At 24 weeks, dupilumab results in a large reduction (improvement) in the SNOT-22 score (mean difference (MD) -19.61, 95% confidence interval (CI) -22.54 to -16.69; 3 studies; 784 participants; high certainty). At between 16 and 52 weeks of follow-up, dupilumab probably results in a large reduction in disease severity, as measured by a 0- to 10-point visual analogue scale (VAS) (MD -3.00, 95% CI -3.47 to -2.53; 3 studies; 784 participants; moderate certainty). This is a global symptom score, including all aspects of chronic rhinosinusitis symptoms. At between 16 and 52 weeks of follow-up, dupilumab may result in a reduction in serious adverse events compared to placebo (5.9% versus 12.5%, risk ratio (RR) 0.47, 95% CI 0.29 to 0.76; 3 studies, 782 participants; low certainty). Anti-IL-5 mAb (mepolizumab) versus placebo/no treatment (all receiving intranasal steroids) Two studies (137 participants) evaluated mepolizumab. Disease-specific HRQL was measured with the SNOT-22. At 25 weeks, the SNOT-22 score may be reduced (improved) in participants receiving mepolizumab (MD -13.26 points, 95% CI -22.08 to -4.44; 1 study; 105 participants; low certainty; MCID 8.9). It is very uncertain whether there is a difference in disease severity at 25 weeks: on a 0- to 10-point VAS, disease severity was -2.03 lower in those receiving mepolizumab (95% CI -3.65 to -0.41; 1 study; 72 participants; very low certainty). It is very uncertain if there is a difference in the number of serious adverse events at between 25 and 40 weeks (1.4% versus 0%; RR 1.57, 95% CI 0.07 to 35.46; 2 studies; 135 participants, very low certainty). Anti-IgE mAb (omalizumab) versus placebo/no treatment (all receiving intranasal steroids) Five studies (329 participants) evaluated omalizumab. Disease-specific HRQL was measured with the SNOT-22. At 24 weeks omalizumab probably results in a large reduction in SNOT-22 score (MD -15.62, 95% CI -19.79 to -11.45; 2 studies; 265 participants; moderate certainty; MCID 8.9). We did not identify any evidence for overall disease severity. It is very uncertain whether omalizumab affects the number of serious adverse events, with follow-up between 20 and 26 weeks (0.8% versus 2.5%, RR 0.32, 95% CI 0.05 to 2.00; 5 studies; 329 participants; very low certainty). AUTHORS' CONCLUSIONS Almost all of the participants in the included studies had nasal polyps (99.8%) and all were using topical nasal steroids for their chronic rhinosinusitis symptoms. In these patients, dupilumab improves disease-specific HRQL compared to placebo. It probably also results in a reduction in disease severity, and may result in a reduction in the number of serious adverse events. Mepolizumab may improve disease-specific HRQL. It is very uncertain if there is a difference in disease severity or the number of serious adverse events. Omalizumab probably improves disease-specific HRQL compared to placebo. It is very uncertain if there is a difference in the number of serious adverse events. There was no evidence regarding the effect of omalizumab on disease severity (using global scores that address all symptoms of chronic rhinosinusitis).
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Affiliation(s)
- Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Steve Sharp
- National Institute for Health and Care Excellence, Manchester, UK
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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Beck A, LeBlanc JC, Morissette K, Hamel C, Skidmore B, Colquhoun H, Lang E, Moore A, Riva JJ, Thombs BD, Patten S, Bragg H, Colman I, Goldfield GS, Nicholls SG, Pajer K, Potter BK, Meeder R, Vasa P, Hutton B, Shea BJ, Graham E, Little J, Moher D, Stevens A. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev 2021; 10:24. [PMID: 33436094 PMCID: PMC7802305 DOI: 10.1186/s13643-020-01568-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Major depressive disorder is common, debilitating, and affects feelings, thoughts, mood, and behaviors. Childhood and adolescence are critical periods for the development of depression and adolescence is marked by an increased incidence of mental health disorders. This protocol outlines the planned scope and methods for a systematic review update that will evaluate the benefits and harms of screening for depression in children and adolescents. METHODS This review will update a previously published systematic review by Roseman and colleagues. Eligible studies are randomized controlled trials (RCTs) assessing formal screening in primary care to identify children or adolescents not already self-reporting symptoms of, diagnosed with, or treated for depression. If no or only a single RCT is available, we will consider controlled studies without random assignment. Studies of participants with characteristics associated with an elevated risk of depression will be analyzed separately. Outcomes of interest are symptoms of depression, classification of major depressive disorder based on a validated diagnostic interview, suicidality, health-related quality of life, social function, impact on lifestyle behavior (e.g., substance use, school performance, lost time at work, or school), false-positive results, overdiagnosis, overtreatment, labeling, and other harms such as those arising from treatment. We will search MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, and grey literature sources. Two reviewers will independently screen the titles and abstracts using the liberal accelerated method. Full-text screening will be performed independently by two reviewers using pre-specified eligibility criteria. Data extraction and risk of bias assessments will be performed independently by two reviewers. Pre-planned analyses, including subgroup and sensitivity analyses, are detailed within this protocol. Two independent reviewers will assess and finalize through consensus the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and prepare GRADE evidence profiles and summary of findings tables for each outcome of interest. DISCUSSION The systematic review will provide a current state of the evidence of benefits and harms of depression screening in children and adolescents. These findings will be used by the Canadian Task Force on Preventive Health Care to inform the development of recommendations on depression screening. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020150373.
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Affiliation(s)
- Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
| | - John C. LeBlanc
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | | | - Candyce Hamel
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
| | - Eddy Lang
- University of Calgary Cumming School of Medicine, Calgary, AB Canada
- Alberta Health Services, Calgary, AB Canada
| | - Ainsley Moore
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, Hamilton, ON Canada
| | - John J. Riva
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, Hamilton, ON Canada
| | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC Canada
- Faculty of Medicine, McGill University, Montreal, QC Canada
| | - Scott Patten
- Department of Community Health Services and Department of Psychiatry, University of Calgary, Calgary, AB Canada
| | - Heather Bragg
- Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Gary S. Goldfield
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | | | - Kathleen Pajer
- Department of Psychiatry, Children’s Hospital of Eastern Ontario, Ottawa Faculty of Medicine, Ottawa, ON Canada
| | - Beth K. Potter
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Robert Meeder
- Waypoint Centre For Mental Health Care, Penetanguishene, ON Canada
| | - Priya Vasa
- Department of Family and Community Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
| | - Beverley J. Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Eva Graham
- Public Health Agency of Canada, Ottawa, ON Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - David Moher
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, ON K1H 8L6 Canada
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Kim C, Han J, Wu T, Bachert C, Fokkens W, Hellings P, Hopkins C, Lee S, Mullol J, Lee JT. Role of Biologics in Chronic Rhinosinusitis With Nasal Polyposis: State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:57-66. [PMID: 32746710 DOI: 10.1177/0194599820939964] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the current literature regarding the role of biologics in the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). DATA SOURCES PubMed/MEDLINE, EMBASE, Cochrane Review, ClinicalTrials.gov. REVIEW METHODS We conducted a comprehensive review of the literature on clinical studies investigating the efficacy of emerging biologics in CRSwNP, with a focus on randomized controlled trials. CONCLUSIONS There appears to be promising evidence to support the safety and efficacy of biologics in CRSwNP with and without asthma for select patients. However, additional large-scale randomized studies with longer follow-up are necessary to determine which patients would benefit the most from these novel systemic treatments. IMPLICATIONS FOR PRACTICE Chronic rhinosinusitis with nasal polyposis refractory to medical and surgical therapy remains a challenging clinical problem for otolaryngologists. However, emerging biologic therapies may offer a new therapeutic option for such patients with recalcitrant disease.
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Affiliation(s)
- Christine Kim
- Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Joseph Han
- Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Tara Wu
- Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, University of Ghent, Ghent, Belgium
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - Peter Hellings
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Stella Lee
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clínic Universitari, Barcelona, Spain
| | - Jivianne T Lee
- Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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13
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Self-Reported Improvement for Chronic Rhinosinusitis Major Symptoms in Patients Treated with Omalizumab. JOURNAL OF RESPIRATION 2020. [DOI: 10.3390/jor1010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the clinical effect of omalizumab therapy on the symptoms of patients with chronic rhinosinusitis (CRS). Methods: This cross-sectional study evaluated CRS major symptom improvement in patients with CRS on omalizumab therapy and patients who met omalizumab therapy indications, but could not access coverage for omalizumab. Changes in overall chronic rhinosinusitis symptom burden and each of the major symptoms of CRS were rated on a 10 cm visual analogue scale (VAS). The Mann–Whitney test was used to compare the symptom improvement between groups. Results: Omalizumab therapy provided a mean overall symptom improvement of 69.5% (individual symptom improvement: facial pain 78.5%, nasal obstruction 69.8%, rhinorrhea 56.2%, and olfaction 55.8%). For the control group, mean overall symptom improvement since omalizumab screening was 16.8% (individual symptom improvement: rhinorrhea 16.4%, nasal obstruction 15.3%, no improvement in facial pain or olfaction). Overall, and for each major symptom, improvement was significantly greater for omalizumab treated patients (p < 0.05). Conclusion: Omalizumab treatment provided significant improvement in every major clinical symptom of CRS in the treated cohort of patients with recalcitrant CRS, in comparison to the control cohort. A well-designed randomized clinical trial is needed to further assess the efficacy and safety of omalizumab treatment for CRS.
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Chong L, Piromchai P, Sharp S, Snidvongs K, Philpott C, Hopkins C, Burton MJ. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev 2020; 2:CD013513. [PMID: 32102112 PMCID: PMC7043934 DOI: 10.1002/14651858.cd013513.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This living systematic review is one of several Cochrane Reviews evaluating the medical management of patients with chronic rhinosinusitis. Chronic rhinosinusitis is common. It is characterised by inflammation of the nasal and sinus linings, nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. It occurs with or without nasal polyps. 'Biologics' are medicinal products produced by a biological process. Monoclonal antibodies are one type, already evaluated in related inflammatory conditions (e.g. asthma and atopic dermatitis). OBJECTIVES To assess the effects of biologics for the treatment of chronic rhinosinusitis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; CENTRAL (2019, Issue 9); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 16 September 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) with at least three months follow-up comparing biologics (currently, monoclonal antibodies) against placebo/no treatment in patients with chronic rhinosinusitis. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), disease severity and serious adverse events (SAEs). The secondary outcomes were avoidance of surgery, extent of disease (measured by endoscopic or computerised tomography (CT) score), generic HRQL and adverse events (nasopharyngitis, including sore throat). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included eight RCTs. Of 986 adult participants, 984 had severe chronic rhinosinusitis with nasal polyps; 43% to 100% of participants also had asthma. Three biologics, with different targets, were evaluated: dupilumab, mepolizumab and omalizumab. All the studies were sponsored or supported by industry. Anti-IL-4Rα mAb (dupilumab) versusplacebo/no treatment (all receiving intranasal steroids) Three studies (784 participants) evaluated dupilumab. Disease-specific HRQL was measured with the SNOT-22 (score 0 to 110; minimal clinically important difference (MCID) 8.9 points). At 24 weeks, the SNOT-22 score was 19.61 points lower (better) in participants receiving dupilumab (mean difference (MD) -19.61, 95% confidence interval (CI) -22.54 to -16.69; 3 studies; 784 participants; high certainty). Symptom severity measured on a 0- to 10-point visual analogue scale (VAS) was 3.00 lower in those receiving dupilumab (95% CI -3.47 to -2.53; 3 studies; 784 participants; moderate certainty). The risk of serious adverse events may be lower in the dupilumab group (risk ratio (RR) 0.45, 95% CI 0.28 to 0.75; 3 studies; 782 participants; low certainty). The number of participants requiring nasal polyp surgery (actual or planned) during the treatment period is probably lower in those receiving dupilumab (RR 0.17, 95% CI 0.05 to 0.52; 2 studies; 725 participants; moderate certainty). Change in the extent of disease using the Lund Mackay computerised tomography (CT) score (0 to 24, higher = worse) was -7.00 (95% CI -9.61 to -4.39; 3 studies; 784 participants; high certainty), a large effect favouring the dupilumab group. The EQ-5D visual analogue scale (0 to 100, higher = better; MCID 8 points) was used to measure change in generic quality of life. The mean difference favouring dupilumab was 8.59 (95% CI 5.31 to 11.86; 2 studies; 706 participants; moderate certainty). There may be little or no difference in the risk of nasopharyngitis (RR 0.95, 95% CI 0.72 to 1.25; 3 studies; 783 participants; low certainty). Anti-IL-5 mAb (mepolizumab) versusplacebo/no treatment (all receiving intranasal steroids) Two studies (137 participants) evaluated mepolizumab. Disease-specific HRQL measured with the SNOT-22 at 25 weeks was 13.26 points lower (better) in participants receiving mepolizumab (95% CI -22.08 to -4.44; 1 study; 105 participants; low certainty; MCID 8.9). It is very uncertain whether there is a difference in s ymptom severity: on a 0- to 10-point VAS symptom severity was -2.03 lower in those receiving mepolizumab (95% CI -3.65 to -0.41; 1 study; 72 participants; very low certainty). It is very uncertain if there is difference in the risk of serious adverse events (RR 1.57, 95% CI 0.07 to 35.46; 2 studies; 135 participants, very low certainty). It is very uncertain whether or not the overall risk that patients still need surgery at trial end is lower in the mepolizumab group (RR 0.78, 95% CI 0.64 to 0.94; 2 studies; 135 participants; very low certainty). It is very uncertain whether mepolizumab reduces the extent of disease as measured by endoscopic nasal polyps score (scale range 0 to 8). The mean difference was 1.23 points lower in the mepolizumab group (MD -1.23, 95% -1.79 to -0.68; 2 studies; 137 participants; very low certainty). The difference in generic quality of life (EQ-5D) was 5.68 (95% CI -1.18 to 12.54; 1 study; 105 participants; low certainty), favouring the mepolizumab group. This difference is smaller than the MCID of 8 points. There may be little or no difference in the risk of nasopharyngitis (RR 0.73, 95% 0.36 to 1.47; 2 studies; 135 participants; low certainty). Anti-IgE mAb (omalizumab) versus placebo/no treatment (all receiving intranasal steroids) Three very small studies (65 participants) evaluated omalizumab. We are very uncertain about the effect of omalizumab on disease-specific HRQL, severe adverse events, extent of disease (CT scan scores), generic HRQL and adverse effects. AUTHORS' CONCLUSIONS In adults with severe chronic rhinosinusitis and nasal polyps, using regular topical nasal steroids, dupilumab improves disease-specific HRQL compared to placebo, and reduces the extent of the disease as measured on a CT scan. It probably also improves symptoms and generic HRQL and there is no evidence of an increased risk of serious adverse events. It may reduce the need for further surgery. There may be little or no difference in the risk of nasopharyngitis. In similar patients, mepolizumab may improve both disease-specific and generic HRQL. It is uncertain whether it reduces the need for surgery or improves nasal polyp scores. There may be little or no difference in the risk of nasopharyngitis. It is uncertain if there is a difference in symptom severity and the risk of serious adverse events. We are uncertain about the effects of omalizumab.
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Affiliation(s)
| | - Patorn Piromchai
- Faculty of Medicine, Khon Kaen UniversityDepartment of OtorhinolaryngologyKhon KaenThailand
| | - Steve Sharp
- National Institute for Health and Care ExcellenceLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BT
| | - Kornkiat Snidvongs
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | - Carl Philpott
- Norwich Medical School, University of East AngliaDepartment of MedicineNorwichUKNR4 7TJ
| | - Claire Hopkins
- Guy's HospitalENT DepartmentGerat Maze PondLondonUKSE1 9RT
| | - Martin J Burton
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
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YALCIN ARZUDIDEM, ONBASI KEVSER, UZUN RUSEN, HERTH FELIX, SCHNABEL PHILIPPALBERT. Human(ized) monoclonal antibodies in atopic patients - state of the art. Cent Eur J Immunol 2020; 45:195-201. [PMID: 33456331 PMCID: PMC7792442 DOI: 10.5114/ceji.2020.97909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/13/2017] [Indexed: 02/05/2023] Open
Abstract
Asthma is an important chronic disease affecting a lot of people worldwide. Treatment options for asthma like biological agents are being developed more frequently nowadays. Despite a lot of treatment options, some patients still remain symptomatic. As more and more practitioners choose treatment with biologic agents as a convenient way of therapy, biologic agents and other valuable methods must be discovered in order to cope with a growing number of treatment agents. This manuscript emphasizes on new generation monoclonal human(ized) antibodies in asthmatics and off-label use . The first developed biologic agent is the anti-immunoglobulin E monoclonal antibody called omalizumab. Currently it is an approved treatment option for asthma.
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Affiliation(s)
- ARZU DIDEM YALCIN
- Department of Internal Medicine, Allergy and Clinical Immunology, Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Department of Allergy and Clinical Immunology, Antalya Training and Research Hospital, University of Medical Science, Antalya, Turkey
- Correspondence: Arzu Didem Yalcin, Department of Internal Medicine, Allergy and Clinical Immunology, Genomics Research Center, Academia Sinica, 11529 Tapei,Taiwan, e-mail:
| | - KEVSER ONBASI
- Department of Internal Medicine, Allergy and Clinical Immunology, Dumlupinar University, Kütahya, Turkey
| | - RUSEN UZUN
- Department of Pulmonology, Antalya Training and Research Hospital, University of Medical Science, Antalya, Turkey
| | - FELIX HERTH
- Department of Pulmonary and Critical Care Medicine, Thoraxklinik Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
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16
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Mostafa BE, Fadel M, Mohammed MA, Hamdi TAH, Askoura AM. Omalizumab versus intranasal steroids in the post-operative management of patients with allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol 2019; 277:121-128. [DOI: 10.1007/s00405-019-05650-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
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17
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Cui K, Chen Y, Zhou L, Yang C, Du Y, Shi W, Cai Z, Chen J. Generation of IgE-specific cytotoxic T lymphocytes as a novel immunotherapeutic approach for the treatment of allergic asthma. Singapore Med J 2019; 61:212-220. [PMID: 31317199 DOI: 10.11622/smedj.2019068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Overproduction of immunoglobulin E (IgE) by a subset of B cells plays a key role in the pathogenesis of allergic asthma. Anti-IgE monoclonal antibodies have been successfully used to treat the disease, but long-term application is required. METHODS For this study, cytotoxic T lymphocytes (CTLs) against IgE-producing B cells were generated ex vivo by stimulating naive CD8 T cells with IgE-derived peptides presented by Drosophila-derived artificial antigen-presenting cells. Based on the treatment of allergic asthma in mice, the inhibitive effect of this CTL on IgE responses and airway inflammation was determined with the enzyme-linked immunosorbent assay and histochemical method. RESULTS The IgE-specific CTLs effectively lysed target cells in vitro, while the adoptively transferred CTLs specifically inhibited IgE responses and airway inflammation in an asthmatic mouse model. The effect of IgE-specific CTLs is MHC (major histocompatibility complex) Class I-restricted and requires the expression of perforin. CONCLUSION IgE-specific CTLs generated ex vivo may provide a novel treatment for allergic asthma and lead to a new therapy for other immunological disorders.
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Affiliation(s)
- Kangle Cui
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yanna Chen
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Li Zhou
- College Hospital, Zhejiang Sci-Tech University, Hangzhou, China
| | - Chunxia Yang
- Shanghai Yuyan Cell Research Company, Shanghai, China
| | - Yao Du
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Weixing Shi
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China.,Johnson and Johnson Pharmaceutical Research and Development LLC, San Diego, CA, USA
| | - Zeling Cai
- Johnson and Johnson Pharmaceutical Research and Development LLC, San Diego, CA, USA
| | - Jian Chen
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
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18
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Giallongo A, Parisi GF, Licari A, Pulvirenti G, Cuppari C, Salpietro C, Marseglia GL, Leonardi S. Novel therapeutic targets for allergic airway disease in children. Drugs Context 2019; 8:212590. [PMID: 31391855 PMCID: PMC6668505 DOI: 10.7573/dic.212590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of precision medicine is setting up targeted therapies for selected patients that would ideally have high effectiveness and few side effects. This is made possible by targeted therapy drugs that selectively act on a specific pathway. Precision medicine is spreading to many medical specialties, and there is increasing interest in the context of allergic airway diseases, such as allergic rhinitis, chronic rhinosinusitis, and asthma. This review is an update of new targets in the treatment of childhood allergic upper airway diseases and asthma, including the most recent biologic drugs that have already been licensed or are in the pipeline to be tested with children.
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Affiliation(s)
- Alessandro Giallongo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giulio Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Caterina Cuppari
- Department of Human Pathology of the Adult and Developmental Age 'Gaetano Barresi,' Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Carmelo Salpietro
- Department of Human Pathology of the Adult and Developmental Age 'Gaetano Barresi,' Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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19
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Hamel C, Lang E, Morissette K, Beck A, Stevens A, Skidmore B, Colquhoun H, LeBlanc J, Moore A, Riva JJ, Thombs BD, Colman I, Grigoriadis S, Nicholls SG, Potter BK, Ritchie K, Robert J, Vasa P, Lauria-Horner B, Patten S, Vigod SN, Hutton B, Shea BJ, Shanmugasegaram S, Little J, Moher D. Screening for depression in women during pregnancy or the first year postpartum and in the general adult population: a protocol for two systematic reviews to update a guideline of the Canadian Task Force on Preventive Health Care. Syst Rev 2019; 8:27. [PMID: 30660183 PMCID: PMC6339426 DOI: 10.1186/s13643-018-0930-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/25/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2018, the World Health Organization reported that depression is the most common cause of disability worldwide, with over 300 million people currently living with depression. Depression affects an individual's physical health and well-being, impacts psychosocial functioning, and has specific negative short- and long-term effects on maternal health, child health, developmental trajectories, and family health. The aim of these reviews is to identify evidence on the benefits and harms of screening for depression in the general adult population and in pregnant and postpartum women. METHODS Search strategies were developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library, and a randomized controlled trial filter will be used. The general adult review will be an update of a systematic review previously used by the Canadian Task Force on Preventive Health Care for their 2013 guideline recommendation. The search strategy will be updated and will start from the last search date of the previous review (May 2012). The pregnant and postpartum review will be a de novo review with no date restriction. For both reviews, we will search for unpublished documents following the CADTH Grey Matters checklist and relevant websites. Titles and abstracts will be screened using the liberal accelerated method. Two reviewers will independently screen full-text articles for relevance using pre-specified eligibility criteria and assess the risk of bias of included studies using the Cochrane Risk of Bias tool. Outcomes of interest for the general adult population review include symptoms of depression or diagnosis of major depressive disorder, health-related quality of life, day-to-day functionality, lost time at work/school, impact on lifestyle behaviour, suicidality, false-positive result, labelling/stigma, overdiagnosis or overtreatment, and harms of treatment. Outcomes of interest for the pregnant and postpartum review include mental health outcomes (e.g. diagnosis of major depressive disorder), parenting outcomes (e.g. mother-child interactions), and infant outcomes (e.g. infant health and development). DISCUSSION These two systematic reviews will offer informative evaluations of depression screening. The findings will be used by the Task Force to help develop guideline recommendations on depression screening in the general adult population and in pregnant and postpartum women in Canada. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42018099690).
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Affiliation(s)
- Candyce Hamel
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Eddy Lang
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | | | - Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - John LeBlanc
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ainsley Moore
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, Hamilton, Canada
| | - John J Riva
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, Hamilton, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Beth K Potter
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kerri Ritchie
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Priya Vasa
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Scott Patten
- Department of Community Health Services and Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley J Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Moher
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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20
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Ho J, Alvarado R, Rimmer J, Sewell WA, Harvey RJ. Atopy in chronic rhinosinusitis: impact on quality of life outcomes. Int Forum Allergy Rhinol 2019; 9:501-507. [PMID: 30604578 DOI: 10.1002/alr.22272] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T-helper 2 and immunoglobulin E (IgE)-mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient-reported outcomes measures (PROMs) were investigated. METHODS A cross-sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum-specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L). RESULTS A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ2 (1) = 5.97, p = 0.02) and need to blow nose (χ2 (1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs. CONCLUSION Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease.
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Affiliation(s)
- Jacqueline Ho
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Sydney, Australia.,Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - William A Sewell
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Immunology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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21
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Immunomodulators in chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 2018; 4:186-192. [PMID: 30506050 PMCID: PMC6251964 DOI: 10.1016/j.wjorl.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To provide new insight into how chronic rhinosinusitis (CRS) is conceptualized and treated with a focus on immunomodulator therapy. Data sources Pubmed, Medline, and Embase. Methods A current review of the evidence is provided for immunomodulators investigated for treatment of CRS with nasal polyps (CRSwNP). Results Biologic therapies targeting IgE, IL-4, IL-5, and IL-13 for the treatment of CRSwNP have shown promise and are currently in phase 3 trials. Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in 6 studies, anti-interleukin (IL)-5 therapy in 3 studies (2 mepolizumab, 1 reslizumab) and anti IL-4/IL-13 (dupilumab) therapy in one study. Studied outcomes varied, but the majority of trials identified clinical benefit of therapy over placebo. Other potential targets include thymic stromal lymphopoetin (TSLP), IL-25, IL-33, and sialic acid-binding immunoglobulin-type lectin (Siglec)-8. Small molecule drugs that target the dysregulation of the immune system in CRS are also being investigated for their immunomodulatory effects on inflammation. Conclusion Immunomodulator therapies for CRS currently in development will likely provide another therapeutic option for patients who have severe disease unresponsive to corticosteroids and surgery. Targeted monoclonal antibody therapies have shown encouraging results and phase 3 trials are underway. IL-4/IL-13 inhibition has shown the most promise to date. Further larger, well-designed trials are needed to improve understanding of these molecules and to offer endotype-driven therapies in the management of CRS. None of these therapeutics have shown long-term immunomodulation when discontinued and therefore further investigation into the pathomechanism of disease continues to be needed.
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Smith KA, Pulsipher A, Gabrielsen DA, Alt JA. Biologics in Chronic Rhinosinusitis: An Update and Thoughts for Future Directions. Am J Rhinol Allergy 2018; 32:412-423. [PMID: 30021447 DOI: 10.1177/1945892418787132] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Potential biologic therapies for chronic rhinosinusitis (CRS) is a growing field of interest and research. Biologics target specific immune cells or inflammatory pathways within a disease process, increasing drug efficacy while reducing complications. The success of biologics in other inflammatory conditions such as asthma and atopic dermatitis has spurred much of the corresponding research in CRS. A rapid expansion in the volume of research concerning biologic therapies with potential crossover to treating CRS has made it difficult to stay current. Furthermore, much of the literature has been focused on allergy, asthma, and immunology subspecialties. As the role for biologic therapies in CRS continues to expand, it is increasingly important for otolaryngologists to remain up to date on their progression. Objective The objectives of this review are to provide an update on the growing field of biologics for otolaryngologists who treat CRS and discuss potential future areas of research. Methods A literature review of biologic therapies studied in CRS was performed. In addition, a detailed review of all biologic therapies targeting inflammatory markers involved in Th1-, Th2-, and Th17-mediated inflammation was performed to identify potential areas for future research. The role for biologic therapies in CRS, endotypes of CRS, current biologic therapies studies in CRS, and future areas for research were reviewed. Results Sixty-nine unique biologic therapies have been developed for Th1-, Th2-, and Th17-mediated inflammation. Five biologics are currently being investigated for use in patients with CRS with nasal polyposis. Conclusions As the field of biologics continues to expand, remaining up to date on the current literature may help clinicians identify patients who may benefit from biologic therapies. In addition, ongoing research in other inflammatory disorders with shared pathophysiology to CRS may reveal other potential therapies for CRS that have not previously been investigated.
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Affiliation(s)
- Kristine A Smith
- 1 Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Abigail Pulsipher
- 1 Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,2 GlycoMira Therapeutics, Inc., Salt Lake City, Utah
| | - David A Gabrielsen
- 1 Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeremiah A Alt
- 1 Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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23
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Seif F, Ghalehbaghi B, Aazami H, Mohebbi A, Ahmadi A, Falak R, Babaheidarian P, Najafi M, Khoshmirsafa M, Ghalehbaghi S, Shekarabi M. Frequency of CD4 + and CD8 + T cells in Iranian chronic rhinosinusitis patients. Allergy Asthma Clin Immunol 2018; 14:47. [PMID: 30002685 PMCID: PMC6034261 DOI: 10.1186/s13223-018-0270-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
Background Chronic Rhinosinusitis (CRS) is a persistent inflammatory disease affecting paranasal sinuses. CRS is categorized into two distinct subgroups defined as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Although several immune cells are involved in the CRS pathogenesis, the role of T cells is not fully understood. The objective of the present study was to evaluate the frequency of CD4+ and CD8+ T cells and macrophages in the sinonasal mucosa of CRS patients, as well as to investigate the specific transcription factors for Th1, Th2, Th17, and Treg cells. Methods In this study, 15 healthy controls, 12 CRSsNP, and 23 CRSwNP patients participated. CD4+, CD8+, and CD68+ cells were investigated in the sinonasal tissues using immunohistochemistry. The expression of transcription factors related to Th subsets (T-bet, GATA3, Ror-γt, and FoxP3) was evaluated using real-time PCR. Furthermore, CRSwNP patients were defined as eosinophilic when eosinophils consisted of more than 10% of total inflammatory cells. The Kruskal–Wallis, Mann–Whitney, and Spearman tests were used in statistical analyses. Results The median (range) age of the studied groups was: 32 (14–67) for CRSwNP, 28 (10–43) for CRSsNP, and 27 (17–44) for controls. The number of eosinophils in CRSwNP patients was higher than two other groups, whereas neutrophils were elevated in both CRSwNP and CRSsNP groups in comparison to controls. The frequency of CD4+ and CD8+ T cells, macrophages, and total inflammatory cells were significantly increased in CRSwNP and CRSsNP patients compared with controls. The mRNA expression of GATA3 was increased in CRSwNP patients while mRNA expression of Ror-γt was elevated in CRSsNP patients. No significant difference was observed in T-bet mRNA expression among three groups. Both CRSwNP and CRSsNP patients showed decreased FoxP3 mRNA expression in comparison to controls. Conclusion The frequency of CD4+ and CD8+ T cells was elevated in CRS patients. In addition, we demonstrated Th2 dominance in CRSwNP patients and Th17 dominance in CRSsNP patients, implicating different mechanisms may underlie the disease. Better CRS classification and targeted therapeutic strategies may be achievable by determining the pattern of infiltrating inflammatory cells. Therefore, further experimental investigations on T cells are needed.
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Affiliation(s)
- Farhad Seif
- 1Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,2ENT and Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Ghalehbaghi
- 2ENT and Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Aazami
- 1Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohebbi
- 2ENT and Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Aslan Ahmadi
- 2ENT and Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Falak
- 1Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,3Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Pegah Babaheidarian
- 4Department of Pathology, Rasoul Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Najafi
- 5Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Khoshmirsafa
- 1Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sahand Ghalehbaghi
- 2ENT and Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shekarabi
- 1Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,3Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
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Ho J, Hamizan AW, Alvarado R, Rimmer J, Sewell WA, Harvey RJ. Systemic Predictors of Eosinophilic Chronic Rhinosinusitis. Am J Rhinol Allergy 2018; 32:252-257. [PMID: 29862828 DOI: 10.1177/1945892418779451] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Eosinophilic chronic rhinosinusitis (eCRS) is linked with skewed T-helper 2 or immunoglobulin E (IgE)-mediated allergic responses, with differing diagnosis, prognosis, and management to non-eCRS. Objective The association between biomarkers and eCRS was investigated to assess the predictors of eCRS. Methods A cross-sectional study of adult patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery was conducted. eCRS was defined by histopathological assessment showing >10 eosinophils/high-power field on sinus mucosal biopsy. Blood tests were performed preoperatively and assessed for a full blood count including eosinophils and a white cell count (WCC) as well as biochemical markers of inflammation and atopy including Immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ImmunoCAP testing for serum-specific IgE. Comparisons between eCRS and non-eCRS patients were performed. Results 345 patients (48.1% female, age 48.72 ± 15.06 years) were recruited, with 206 (59.7%) identified as eCRS, 41% with asthma and 47% CRS with nasal polyps. eCRS patients were more likely to have asthma ( P < .01) and nasal polyps ( P < .01). Blood eosinophils were significantly elevated in eCRS (0.42±0.34 vs 0.17±0.13 × 109/L, P < .01) as were eosinophils as a ratio of WCC (6.21 ± 4.48 vs 2.55 ± 1.84, P < .01). ESR was decreased when compared with non-eCRS (8.1±7.87 vs 10.65±11.91, P = .03). Receiver operating characteristic curve analysis predicted high tissue eosinophilia at blood eosinophil levels above 0.24 × 109/L (sensitivity 70.9%, specificity 78.4%, area under the curve [AUC]: 0.792, P < .01). eCRS was predicted at eosinophil above 4.27% of total WCC (sensitivity 64.1%, specificity 88.5%, AUC 0.797; P < .01; positive predictive value 89.2%, negative predictive value 62.4%, positive likelihood ratio 5.57, and diagnostic odds ratio 13.71). There was no significant association among WCC, CRP, IgE, or ImmunoCAP testing. Conclusion eCRS is associated with elevated blood eosinophils (>0.24 × 109/L), eosinophil ratio (>4.27% of total WCC), and lower ESR when compared with non-eCRS.
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Affiliation(s)
- Jacqueline Ho
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,2 St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Aneeza W Hamizan
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,3 Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Raquel Alvarado
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,4 Woolcock Institute, University of Sydney, Sydney, Australia.,5 Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - William A Sewell
- 2 St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,6 Immunology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Richard J Harvey
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,7 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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25
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Usefulness of our proposed olfactory scoring system during endoscopic sinus surgery in patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2017; 275:415-423. [PMID: 29204922 DOI: 10.1007/s00405-017-4831-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/28/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The primary aim of the current study was to examine the usefulness of our proposed olfactory scoring system in chronic rhinosinusitis (CRS) patients with olfactory disorders (n = 213) receiving endoscopic sinus surgery (ESS). MATERIALS AND METHODS Analyzed patients were divided into two groups: an eosinophilic CRS (ECRS) group (n = 153); and a non-ECRS group (n = 60). The T&T recognition threshold test was used to evaluate olfaction at baseline and at 3 and 12 months after ESS. Patients with mean recognition threshold < 2.0 at 3 or 12 months or with a decrease of ≥ 1.0 as compared with baseline were defined as showing clinical improvement. We scored mucosal conditions as normal (0 points), edema (1 point), and polyp (2 points) at the canopy of olfactory cleft (OC), middle and superior turbinates, superior nasal meatus, and sphenoethmoidal recess during ESS. The total score of OCs (SOCs) was calculated (range 0-20 points). We compared SOCs between ECRS and non-ECRS groups. Factors related to olfactory improvement were also investigated using uni- and multivariate analyses. RESULTS SOCs in the ECRS and non-ECRS groups showed significant correlations with mean recognition thresholds at baseline and at 3 and 12 months. In the multivariate analysis for predicting improvement of mean recognition threshold, lower SOCs were significantly associated with olfactory improvement factors at 3 and 12 months postoperatively in the ECRS group. CONCLUSION SOCs appears promising for estimating olfactory prognosis after ESS in CRS patients.
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Abstract
PURPOSE OF REVIEW The most recent recommendations for the management of both acute (ARS) and chronic rhinosinusitis (CRS) based on the strongest data available for each treatment modality are summarized in this review. The clinical relationships between CRS and its comorbidities are also discussed. RECENT FINDINGS The most promising advances in rhinosinusitis management involve the use of mAbs (anti-IgE, anti-IL-5, anti-IL-4Rα) in trials of CRS with nasal polyposis. Otherwise, the mainstays of treatment for both ARS and CRS have largely remained the same over the past several years. SUMMARY The treatment of ARS primarily involves symptomatic control with intranasal corticosteroids and nasal saline irrigation; antibiotics should be reserved for the patients who are believed to have bacterial rhinosinusitis. Treating CRS effectively involves using intranasal corticosteroids and irrigation, systemic corticosteroids, and potentially systemic antibiotics. Biologics (mAbs) have shown benefit in clinical studies. Providers should also be aware of concomitant disease processes that may afflict patients with CRS.
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Medical therapy, refractory chronic rhinosinusitis, and productivity costs. Curr Opin Allergy Clin Immunol 2017; 17:5-11. [PMID: 27906696 DOI: 10.1097/aci.0000000000000329] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to address the most recent advances in the medical therapy for chronic rhinosinusitis (CRS), define recalcitrant and refractory CRS, and discuss the productivity costs associated with CRS. RECENT FINDINGS Recent studies evaluating anti-IL-4 receptor α antibodies and calcium channel blockers have demonstrated promising early results during management of CRS. Recent appropriateness criteria have been developed to assist clinicians with defining which patients have 'refractory' CRS and may be considered candidates for endoscopic sinus surgery. Productivity costs appear to be associated with disease severity and can be reduced with appropriate interventions. SUMMARY Topical corticosteroid therapy and high volume saline irrigation continue to be the cornerstone to medical therapy, whereas use of systemic corticosteroids and antibiotics depends on CRS phenotype and presence of acute exacerbation. More research is needed before routine use of novel immunomodulatory therapies such as anti-IL5, anti-IgE, anti-IL4, and calcium channel blockers. Clinicians should apply an appropriate definition for refractory CRS when discussing role of sinus surgery. Assessing the degree of work productivity impairment can assist in treatment decision-making and may help predict treatment outcomes.
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Schwartz JS, Tajudeen BA, Cohen NA. Medical management of chronic rhinosinusitis – a review of traditional and novel medical therapies. Expert Opin Investig Drugs 2017; 26:1123-1130. [DOI: 10.1080/13543784.2017.1371699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Joseph S Schwartz
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University, Chicago, USA
| | - Noam A Cohen
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA, USA
- Monell Chemical Senses Center, Philadelphia, PA, USA
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Schwartz JS, Tajudeen BA, Cohen NA. Medical management of chronic rhinosinusitis – an update. Expert Rev Clin Pharmacol 2016; 9:695-704. [DOI: 10.1586/17512433.2016.1150780] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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