Chronic Rhinosinusitis with Polyps and Comorbid Asthma: Results of Reslizumab Treatment

Main Article Content

Natalia Boiko
Irina Stagnieva
Olga Lodochkina

Abstract

BACKGROUND:  Chronic  rhinosinusitis  with  nasal  polyps  (CRSwNP)  and  asthma  are  comorbid,  mutually burdening, difficult-to-treat diseases. The presence of a correlation between the severity of the course of CRSwNP and eosinophilic asthma, the  proximity of the endotypes of these diseases, and the success in the application of humanized monoclonal antibodies for the treatment of severe asthma explain the interest in the study of the possibility of using this group of medications in patients with CRSwNP.


AIM: The present study purposes to evaluate changes in the severity of CRS symptoms in patients with comorbid asthma during reslizumab treatment. The clinical effect of the treatment, the dynamics of subjective and objective characteristics of (CRSwNP) and asthma symptoms, indicators of general and local eosinophilia have been analyzed.


MATERIALS AND METHODS: The study involved 18 patients with severe eosinophilic asthma, treated with reslizumab. Research protocol: the first examination conducted before reslizumab treatment included an assessment of clinical symptoms using Sino-nasal outcome test-22 and asthma control test, endoscopic examination of the nasal cavity, computed tomography of the paranasal sinuses, rhinocytogram, determination of the content of eosinophils and eosinophil cation protein in the blood, spirometry. Evaluation of the results of treatment was carried out after 6 injections of reslizumab at a dose of 3 mg/kg 1 time every 4 weeks. The obtained data were processed by means of the “Statistica 12.0” program (StatSoft, USA). The  differences in the indicators were considered statistically significant at p < 0.05.


RESULTS: After 6 injections of reslizumab both a noticeable improvement in asthma control and a decrease in the severity of the nasal symptoms were noted. A more evident effect in diminution of asthma symptoms due to the use of reslizumab was obtained in patients with severe eosinophilic asthma with CRSwNP compared with cases without polyps.


CONCLUSION: Treatment with reslizumab in patients with eosinophilic asthma and concomitant CRS with polyps and eosinophilic CRS leads not only to improved control of asthma symptoms but also to significant regression of nasal symptoms.

Downloads

Download data is not yet available.

Plum Analytics

Article Details

How to Cite
1.
Boiko N, Stagnieva I, Lodochkina O. Chronic Rhinosinusitis with Polyps and Comorbid Asthma: Results of Reslizumab Treatment. SEE J Immunol [Internet]. 2023 Jun. 20 [cited 2024 May 20];6(1):39-44. Available from: https://seejim.eu/index.php/seejim/article/view/6039
Section
Allergology

References

Akdis CA, Bachert C, Cingi C, Dykewicz MS, Hellings PW, Naclerio RM, et al. Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2013;131(6):1479-90. https://doi.org/10.1016/j.jaci.2013.02.036 PMid:23587334

Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449-56.e4. https://doi.org/10.1016/j.jaci.2015.12.1324 PMid:26949058

Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl 29):1-464. https://doi.org/10.4193/rhin20.600 PMid:32077450

Bresciani M, Paradis L, Des Roches A, Vernhet H, Vachier I, Godard P, et al. Rhinosinusitis in severe asthma. J Allergy Clin Immunol. 2001;107(1):73-80. https://doi.org/10.1067/mai.2001.111593 PMid:11149994

Weinstein SF, Katial RK, Bardin P, Korn S, McDonald M, Garin M, et al. Effects of reslizumab on asthma outcomes in a subgroup of eosinophilic asthma patients with self-reported chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2019;7(2):589-96.e3. https://doi.org/10.1016/j.jaip.2018.08.021 PMid:30193936

Promsopa C, Kansara S, Citardi MJ, Fakhri S, Porter P, Luong A. Prevalence of confirmed asthma varies in chronic rhinosinusitis subtypes. Int Forum Allergy Rhinol. 2016;6(4):373-7. https://doi.org/10.1002/alr.21674 PMid:26678021

Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2016;4(4):565-72. https://doi.org/10.1016/j.jaip.2016.04.012 PMid:27393770

Bachert C, Claeys SE, Tomassen P, van Zele T, Zhang N. Rhinosinusitis and asthma: A link for asthma severity. Curr Allergy Asthma Rep. 2010;10(3):194-201. https://doi.org/10.1007/s11882-010-0096-0 PMid:20424997

Huang CC, Wang CH, Fu CH, Huang CC, Chang PH, Chen IW, et al. The link between chronic rhinosinusitis and asthma:Aquestionnaire- based study. Medicine (Baltimore). 2016;95(31):e4294. https://doi.org/10.1097/md.0000000000004294 PMid:27495032

Van Zele T, Holtappels G, Gevaert P, Bachert C. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014;28(3):192-8. https://doi.org/10.2500/ajra.2014.28.4033 PMid:24980230

Wenzel SE. Asthma phenotypes: The evolution from clinical to molecular approaches. Nat Med. 2012;18(5):716-25. https://doi.org/10.1038/nm.2678 PMid:22561835

Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global Strategy for Asthma Management and Prevention: GINA executive summary. Eur Respir J. 2008;31:143-78. https://doi.org/10.1183/09031936.00138707

Koennecke M, Klimek L, Mullol J, Gevaert P, Wollenderg B. Subtyping of polyposis nasi: Phenotypes, endotypes and comorbidities. Allergo J Int. 2018;27(2):56-65. https://doi.org/10.1007/s40629-017-0048-5 PMid:29564208

Corren J. New targeted therapies for uncontrolled asthma. J Allergy Clin Immunol Pract. 2019;7(5):1394-403. https://doi.org/10.1016/j.jaip.2019.03.022 PMid:31076057

De Filippo M, Votto M, Licari A, Pagella F, Benazzo M, Ciprandi G, et al. Novel therapeutic approaches targeting endotypes of severe airway disease. Expert Rev Respir Med. 2021;15(10):1303-16. https://doi.org/10.1080/17476348.2021.1937132 PMid:34056983

Wu D, Bleier BS, Li L, Zhan X, Zhang L, Wei Y, et al. Clinical phenotypes of nasal polyps and comorbid asthma based on cluster analysis of disease history. J Allergy Clin Immunol Pract. 2018;6(4):1297-305.e1 https://doi.org/10.1016/j.jaip.2017.09.020 PMid:29100865

Fokkens WJ, Lund V, Bachert C, Mullol J, Bousquet J, Canonica GW, et al. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy. 2019;74(12):2312-9. https://doi.org/10.1111/all.13875 PMid:31090937

Kariyawasam HH, James LK, Gane SB. Dupilumab: Clinical efficacy of blocking IL-4/IL-13 signalling in chronic rhinosinusitis with nasal polyps. Drug Des Devel Ther. 2020;14:1757-69. https://doi.org/10.2147/dddt.s243053 PMid:32440101

Boiko NV, Lodochkina OE, Kit MM, Kuleshova VG, Nedashkovskaya NG. Impact of reslizumab on the course of chronic rhinosinusitis in patients with eosinophilic asthma. Vestn Otorinolaringol. 2021;86(2):43-8. https://doi.org/10.17116/otorino20218602143 PMid:33929151

Koski RR, Hill L, Taavola K. Efficacy and safety of biologics for chronic rhinosinusitis with nasal polyps. J Pharm Technol. 2022;38(5):289-96. https://doi.org/10.1177/87551225221105749 PMid:36046351

Legrand F, Klion AD. Biologic therapies targeting eosinophils: Current status and future prospects. J Allergy Clin Immunol Pract.

;3(2):167-74. https://doi.org/10.1016/j.jaip.2015.01.013 PMid:25754717

Reddel HK, FitzGerald JM, Bateman ED, Bacharier LB, Becker A, Brusselle G, et al. GINA 2019: A fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. Eur Respir J. 2019;53(6):1901046. https://doi.org/10.1183/13993003.01046-2019 PMid:31249014

Gallo S, Russo F, Mozzanica F, PretiA, Bandi F, Costantino C, et al. Prognostic value of the Sinonasal Outcome Test 22 (SNOT-22)

in chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2020;40(2):113-21. https://doi.org/10.14639/0392-100X-N0364 PMid:32469005

Matsunaga NY, Ribeiro MA, Saad IA, Morcillo AM, Ribeiro JD, Toro AA. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents. J Bras Pneumol. 2015;41(6):502-8. https://doi.org/10.1590/ S1806-37562015000000186 PMid:26785958

Máspero J. Reslizumab in the treatment of inadequately controlled asthma in adults and adolescents with elevated blood eosinophils: Clinical trial evidence and future prospects. Ther Adv Respir Dis. 2017;11(8):311-25. https://doi.org/10.1177/1753465817717134 PMid:28683596

Settipane RA, Lieberman P. Update on nonallergic rhinitis. Ann Allergy Asthma Immunol. 2001;86(5):494-507; quiz 507-8. https://doi.org/10.1016/s1081-1206(10)62896-7 PMid:11379801

Gevaert P, Lang-Loidolt D, Lackner A, Stammberger H, Staudinger H, Van Zele T, et al. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol. 2006;118(5):1133-41. https://doi.org/10.1016/j.jaci.2006.05.031 PMid:17088140

Boiko NV, Kim AS, Stagnieva IV, Simbirtsev AS. Proinflammatory cytokine content in the saliva of children suffering from chronic tonsillitis. Vestn Otorinolaringol. 2019;84(3):26-31. https://doi.org/10.17116/otorino20198403126 PMid:31486423

Wu Q, Zhang Y, Kong W, Wang X, Yuan L, Zheng R, et al. Which is the best biologic for nasal polyps: Dupilumab, omalizumab, or mepolizumab? A network meta-analysis. Int Arch Allergy Immunol. 2022;183(3):279-88. https://doi.org/10.1159/000519228 PMid:34607329