Chronic rhinosinusitis with nasal polyps: how to identify eligible patients for biologics in clinical practice

Acta Otorhinolaryngol Ital. 2022 Feb;42(1):75-81. doi: 10.14639/0392-100X-N1699.

Abstract
in English, Italian

Objective: This study compared three severity measures for chronic rhinosinusitis with nasal polyps (CRSwNP). The outcome was to identify patients who are eligible for biological therapy.

Methods: 330 adult patients with CRSwNP were examined. Nasal polyp score (NPS), sinonasal outcome test (SNOT-22) and clinical-cytological grading (CCG) were compared. Clinical history, past surgery and asthma control test were also considered.

Results: Only 45 (13.6%) patients had a contextual positivity to the three severity measures. The concordance among tests was slight/fair. Patients with severe disease (all tests positive) had more impaired parameters. The mixed cytotype (OR = 4.07), nasal obstruction (OR = 10.06), post-nasal drip (OR = 1.98), embarrassment (OR = 2.53) and difficulty falling asleep (OR = 1.92) were significantly associated with severe CRSwNP.

Conclusions: To identify candidates for biological therapy, the contextual use of NPS, SNOT-22 and CCG is preferable. In this way, global assessment of CRSwNP, including morphology, inflammation, comorbidity, symptoms and quality of life is possible.

Rinosinusite cronica con poliposi nasale: come individuare i candidati alla terapia biologica nella pratica clinica.

Obiettivo: Questo studio confrontava 3 differenti indici di gravità della rinosinusite cronica con poliposi nasale (RSCcPN). L’obbiettivo era individuare i pazienti eleggibili al trattamento con farmaci biologici.

Metodi: 330 pazienti adulti con RSCcPN erano arruolati. Tutti i pazienti venivano valutati mediante nasal polyp score (NPS), sinonasal outcome test (SNOT-22) e clinical-cytological grading (CCG). Inoltre erano considerati la storia clinica, i pregressi interventi chirurgici ed il controllo dell’asma.

Risultati: Solamente 45 (13,6%) pazienti avevano i 3 indici positivi. La concordanza tra i 3 indici era bassa/modesta. I pazienti con la malattia grave (contestuale positività a tutti i test) avevano peggiori parametri. Il citotipo misto (OR = 4,07), l’ostruzione nasale (OR = 10,06), il post-nasal drip (OR = 1,98), il disagio (OR = 2,53), e la difficoltà ad addormentarsi (OR = 1,92) erano significativamente associati con la malattia grave.

Conclusioni: È preferibile utilizzare contemporaneamente i 3 test per individuare i pazienti candidati alla terapia biologica. In questo modo si può avere un quadro generale della malattia, comprendente la morfologia dei polipi, lo stato di infiammazione, le comorbidità, i sintomi e la qualità della vita.

Keywords: CCG; SNOT-22; biological therapy; chronic rhinosinusitis with nasal polyps; nasal polyp score.

MeSH terms

  • Adult
  • Biological Products* / therapeutic use
  • Humans
  • Nasal Polyps* / complications
  • Quality of Life
  • Rhinitis* / drug therapy
  • Sinusitis* / drug therapy

Substances

  • Biological Products