Open AccessImpact of type 2 targeting biologics on acute exacerbations of chronic rhinosinusitis
Author(s) -
Gayatri Patel,
Elizabeth Kudlaty,
Amina Guo,
Yeh Chen,
Margaret S. Kim,
Caroline P.E. Price,
David B. Conley,
Leslie C. Grammer,
Ravi Kalhan,
Robert C. Kern,
Kris G. McGrath,
Bruce K. Tan,
Sharon R Rosenberg,
Robert P. Schleimer,
Stephanie Shintani Smith,
Whitney W. Stevens,
Kevin C. Welch,
Anju T. Peters
Publication year - 2021
Publication title -
allergy and asthma proceedings
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.643
H-Index - 60
eISSN - 1539-6304
pISSN - 1088-5412
DOI - 10.2500/aap.2021.42.210058
Subject(s) - medicine , omalizumab , mepolizumab , nasal polyps , asthma , sinusitis , cohort , retrospective cohort study , confidence interval , antibiotics , corticosteroid , rate ratio , gastroenterology , immunology , immunoglobulin e , eosinophil , antibody , microbiology and biotechnology , biology
Background: Acute exacerbations of chronic rhinosinusitis (AECRS) are associated with significant morbidity and decreased quality of life. There are sparse data assessing the real-world impact of biologics on AECRS. Objectives: We sought to determine the impact of type 2-targeting biologics on the frequency of medication use for AECRS episodes. Methods: Antibiotic and/or systemic corticosteroid courses for AECRS were identified in a retrospective study from November 2015 to February 2020, at a single academic health system. The estimated yearly rates for antibiotic and corticosteroid courses were evaluated before and after initiation of type 2 biologics. Results: One-hundred and sixty-five patients with chronic rhinosinusitis (CRS) had received either omalizumab (n = 12), mepolizumab (n = 42), benralizumab (n = 44), dupilumab (n = 61), or reslizumab (n = 6). Seventy percent had CRS with nasal polyps, and 30% had CRS without nasal polyps. All the patients had asthma. When all the biologics were combined, the estimated yearly rate for antibiotics for AECRS decreased from 1.34 (95% confidence interval [CI], 1.12-1.59) to 0.68 (95% CI, 0.52-0.88) with biologic use (49% reduction, p < 0.001). Those with frequent AECRS (three or more courses of antibiotics in the 1 year before biologic use) had a larger degree of reduction, with an estimated yearly rate of 4.15 (95% CI, 3.79-4.55) to 1.58 (95% CI, 1.06-2.35) with biologic use (n = 27; 62% reduction; p < 0.001). Within the total cohort, the estimated yearly rate for systemic corticosteroids for AECRS decreased from 1.69 (95% CI, 1.42-2.02) to 0.68 (95% CI, 0.53-0.88) with biologic use (60% reduction; p < 0.001). Conclusion: Type 2-targeting biologics reduced medication use for AECRS. This suggested that biologics may be a therapeutic option for patients with frequent AECRS.