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Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines
Author(s) -
Agache Ioana,
Song Yang,
AlonsoCoello Pablo,
Vogel Yasmin,
Rocha Claudio,
Solà Ivan,
Santero Marilina,
Akdis Cezmi A.,
Akdis Mubeccel,
Caica Giorgio Walter,
Chivato Tomas,
Giacco Stefano,
Eiwegger Thomas,
Fokkens Wytske,
Georgalas Christos,
Gevaert Philippe,
Hopkins Claire,
Klimek Ludger,
Lund Valerie,
Naclerio Robert,
O'Mahony Liam,
Palkonen Susanna,
Pfaar Oliver,
Schwarze Jürgen,
Soyka Michael B.,
Wang De Yun,
Zhang Luo,
CaneloAybar Carlos,
Palomares Oscar,
Jutel Marek
Publication year - 2021
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.14809
Subject(s) - medicine , nasal polyps , mepolizumab , omalizumab , cochrane library , relative risk , adverse effect , dupilumab , sinusitis , confidence interval , chronic rhinosinusitis , surgery , asthma , immunoglobulin e , immunology , antibody , eosinophil
Abstract This systematic review evaluates the efficacy and safety of biologicals for chronic rhinosinusitis with nasal polyps (CRSwNP) compared with the standard of care. PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CRSwNP‐related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. RCTs evaluated (dupilumab‐2, omalizumab‐4, mepolizumab‐2, and reslizumab‐1) included 1236 adults, with follow‐up of 20–64 weeks. Dupilumab reduces the need for surgery (NFS) or oral corticosteroid (OCS) use (RR 0.28; 95% CI 0.20–0.39, moderate certainty) and improves with high certainty smell evaluated with UPSIT score (mean difference (MD) +10.54; 95% CI +9.24 to +11.84) and quality of life (QoL) evaluated with SNOT‐22 (MD −19.14; 95% CI −22.80 to −15.47), with fewer treatment‐related adverse events (TAEs) (RR 0.95; 95% CI 0.89–1.02, moderate certainty). Omalizumab reduces NFS (RR 0.85; 95% CI 0.78–0.92, high certainty), decreases OCS use (RR 0.38; 95% CI 0.10–1.38, moderate certainty), and improves high certainty smell (MD +3.84; 95% CI +3.64 to +4.04) and QoL (MD −15.65; 95% CI −16.16 to −15.13), with increased TAE (RR 1.73; 95% CI 0.60–5.03, moderate certainty). There is low certainty for mepolizumab reducing NFS (RR 0.78; 95% CI 0.64–0.94) and improving QoL (MD −13.3; 95% CI −23.93 to −2.67) and smell (MD +0.7; 95% CI −0.48 to +1.88), with increased TAEs (RR 1.64; 95% CI 0.41–6.50). The evidence for reslizumab is very uncertain.