Document Type
Article
Publication Date
7-28-2023
Abstract
INTRODUCTION: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is often treated with endoscopic sinus surgery (ESS); however, patients may require revision surgery due to recurrence. To date, no studies have compared outcomes for combined surgery and biologic therapy for CRSwNP compared with biologic therapy alone.
METHODS: Retrospective case-control study of CRSwNP patients who underwent ESS while on dupilumab or mepolizumab (ESS-biologic cohort) compared with CRSwNP patients on biologic therapy (biologic-only controls). Cohorts were matched according to indication, aspirin-exacerbated respiratory disease (AERD), sinonasal outcome test-22 (SNOT-22), and total polyp scores.
RESULTS: Sixteen patients underwent ESS while on biologic therapy (13 dupilumab and 3 mepolizumab). Sixteen patients were biologic-only controls. There were no significant differences between indication, baseline SNOT-22 scores, polyp scores, and AERD status between cohorts. Patients underwent surgery a median of 33 days after starting biologic therapy. After 12 months of follow-up, the total polyp score for the ESS-biologic cohort decreased from 4.73 to 0.09 compared with a decrease from 5.22 to 3.38 for the biologic-only controls (95% confidence interval [CI] of difference: -5.37 to -1.38, Cohen's d: 2.40, p = 0.005). In the ESS-dupilumab subanalysis, the ESS-dupilumab cohort had a significant reduction in polyp burden from 4.85 to 0.00 compared with 4.88 to 3.50 for the controls (95% CI of difference: -5.68 to -1.32, Cohen's d: -1.69, p = 0.009).
CONCLUSION: In CRSwNP patients, combined ESS and biologic therapy results in a significant and sustained decrease in polyp burden compared with biologic therapy alone. Larger studies are warranted to further examine the impact of combined therapy.
Recommended Citation
Garvey, Emily; Naimi, Bita; Duffy, Alexander; Hannikainen, Paavali; Kahn, Chase; Farquhar, Douglas; Rosen, Marc; Rabinowitz, Mindy R.; Toskala, Elina; and Nyquist, Gurston G., "Optimizing the Timing of Biologic and Surgical Therapy for Patients With Refractory Chronic Rhinosinusitis With Nasal Polyposis (CRSwNP)" (2023). Department of Otolaryngology - Head and Neck Surgery Faculty Papers. Paper 89.
https://jdc.jefferson.edu/otofp/89
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
PubMed ID
37506043
Language
English
Comments
This article is the author’s final published version in International Forum of Allergy & Rhinology, Volume 14, Issue 3, Mar 2024, Pages 609-749.
The published version is available at https://doi.org/10.1002%2Falr.23246. Copyright © 2023 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.
Publication made possible in part by support through a transformative agreement between Thomas Jefferson University and the publisher.