Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps

Bezerra, Thiago Freire Pinto; Pezato, Rogério; Barros, Pâmella Marletti de; Coutinho, Larissa Leal; Costa, Leidianny Firmino; Pinna, Fabio; Voegels, Richard Louis

doi:10.1016/j.bjorl.2019.09.008

Cited by 9 publications

(7 citation statements)

References 29 publications

(30 reference statements)

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“…15,17 When nasal polyps or severe mucosal oedema were observed during visits after the first 3 months, the patients were given systemic corticosteroids (methylprednisolone tablets, 0.5 mg/kg, 20-24 mg/day) for at least one pulse treatment of 7 days and were subsequently given topical corticosteroids to take in combination with clarithromycin (250 mg/ day) for another 3 months. 18 Six months after ESS, recurrence was diagnosed as remaining evidence of bilateral pedunculated lesions as opposed to cobblestoned mucosa, on an endoscopic examination performed after the maximum amount of medication described above was used. 15,19 The minimum follow-up period was three years, and endpoints were recorded at the closest date from the last follow-up visit.…”

Section: Methodsmentioning

confidence: 99%

“…On the 7th day after ESS, all patients began treatment with saline irrigation (250 mL twice daily), clarithromycin (250 mg/day), and topical corticosteroids (budesonide, mometasone, or fluticasone, 2 sprays in each nostril twice daily) for the first three months after surgery 15,17 . When nasal polyps or severe mucosal oedema were observed during visits after the first 3 months, the patients were given systemic corticosteroids (methylprednisolone tablets, 0.5 mg/kg, 20‐24 mg/day) for at least one pulse treatment of 7 days and were subsequently given topical corticosteroids to take in combination with clarithromycin (250 mg/day) for another 3 months 18 …”

Section: Methodsmentioning

confidence: 99%

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Impaired small airway function in non‐asthmatic chronic rhinosinusitis with nasal polyps

Zheng

Zhao

et al. 2020

Clin Experimental Allergy

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Background: There is clinical evidence for impaired lung function in chronic rhinosinusitis with nasal polyps (CRSwNP) patients, which may be due to a high incidence of asthma comorbidity. The lung function characteristics of non-asthmatic CRSwNP patients are not known. Small airway dysfunction (SAD) is involved in the pathogenesis of asthma. However, whether SAD is detected in non-asthmatic patients with CRSwNPs remains unclear. Objective: This study analysed the lung function of non-asthmatic patients with CRSwNPs and evaluated its clinical relevance in CRSwNPs. Methods: The clinical data for 191 consecutive CRSwNP patients (73 asthmatic and 118 non-asthmatic) and 30 control subjects were prospectively collected. The patients were followed up for at least 3 years (mean [standard deviation], 42.47 ± 8.38 months). Serum and tissue total IgE levels were measured in 95 and 93 patients, respectively. Tissue eosinophil counts were documented in 63 patients. Results: Non-asthmatic CRSwNP patients had decreased forced expiratory flow at 75% of the FVC (FEF 75) and FEF 50 compared to the control subjects, and this difference was related to the severity of CRSwNP. The risk factors for impaired lung function in asthmatic and non-asthmatic patients were duration of asthma and smoking. A multivariate logistic analysis showed that decreased FEF 50 was associated with the recurrence of non-asthmatic CRSwNPs. The lung function of CRSwNP patients negatively correlated with the degree of type-2 inflammation, which was defined by the levels of Eos and IgE in polyp tissues and blood. The SAD of non-asthmatic CRSwNP patients was related to serum IgE levels. Conclusions and clinical relevance: This study provides evidence that non-asthmatic CRSwNP patients may have SAD, which correlated with the severity and recurrence of CRSwNP. The decreased lung function of patients with CRSwNP was related to the degree of type-2 inflammation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impaired small airway function in non‐asthmatic chronic rhinosinusitis with nasal polyps

Zheng

Zhao

et al. 2020

Clin Experimental Allergy

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“…These findings suggest that endotyping may potentially help in treatment selection 125 . Later cohort studies demonstrated a lack of efficacy for macrolides in eosinophilic CRSwNP patients 126,127 . It remains to be established whether responders exhibit T1, T3, null or mixed endotypes.…”

Section: Associations Between Endotypes and Responses To Surgical And...mentioning

confidence: 99%

Endotypes of chronic rhinosinusitis: Relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches

Kato

Peters

Stevens

et al. 2021

Allergy

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Chronic rhinosinusitis (CRS) is a common clinical syndrome that produces significant morbidity and costs to our health system. The study of CRS has progressed from an era focused on phenotype to include endotype-based information. Phenotypic classification has identified clinical heterogeneity in CRS based on endoscopically observed features such as presence of nasal polyps, presence of comorbid or systemic diseases, and timing of disease onset. More recently, laboratory-based findings have established CRS endotype based upon specific mechanisms or molecular biomarkers.Understanding the basis of widespread heterogeneity in the manifestations of CRS is advanced by findings that the three main endotypes, Type 1, 2, and 3, orchestrate the expression of three distinct large sets of genes. The development and use of improved methods of endotyping disease in the clinic are ushering in an expansion of the use of biological therapies targeting Type 2 inflammation now and perhaps other inflammatory endotypes in the near future. The purpose of this review is to discuss the phenotypic and endotypic heterogeneity of CRS from the perspective of advancing the understanding of the pathogenesis and improvement of treatment approaches and outcomes.

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“…On the 7th day after ESS, all patients began to be treated with saline irrigation (250 mL twice a day), clarithromycin, and topical corticosteroids again as above for the first three months after surgery 15,17. During the visits held after 3 months, when nasal polyps or severe mucosal edema were observed, which always accompanies recurrent nasal symptoms, the patients were given systemic corticosteroids (methylprednisolone tablets, 0.5 mg/kg, 20-24 mg/day) for at least one pulse treatment for 7 days and were subsequently given topical corticosteroids to take in combination with clarithromycin (250 mg/day) for another 3 months 18. Compliance of all patients with medical treatment was confirmed during outpatient visits.…”

Section: Methodsmentioning

confidence: 99%

A Nomogram Combing Peripheral Parameters for Estimation of CRSwNP Recurrence

Zheng

Zhao

et al. 2020

Am J Rhinol�Allergy

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Background The preoperative prediction of the recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) remains difficult in clinical practice. Objective We aimed to develop a nomogram that combined peripheral risk factors to clinically predict the recurrence of CRSwNP. Methods Data from 158 CRSwNP patients who underwent endoscopic sinus surgery (ESS) from January 2012 to December 2016 were collected, and the patients were followed up for 3 years. Of these, 96 patients who underwent ESS in an earlier period formed the training cohort for nomogram development, and 62 patients who underwent ESS thereafter formed the validation cohort to confirm the model’s performance. Risk factors for recurrence identified by univariate and multivariate logistic regression were used to create a nomogram. Results The recurrence rate was 29.2% (28/96) for the training cohort and 35.5% (22/62) for the validation cohort. Univariate analysis identified blood eosinophils (Eos), serum IgE level, asthma comorbidity, and the number of previous ESSs as risk factors for recurrence. Among those four parameters, serum IgE level and a previous ESS surgery were identified as two independent risk factors. A nomogram consisting of blood Eos, total serum IgE level, asthma comorbidity, and the number of previous ESSs was constructed, demonstrating a C index of 0.81 (95% CI, 0.79-0.83) and 0.80 (95% CI, 0.77-0.83) for predicting recurrence in the training and validation cohorts, respectively. The nomogram had well-fitted calibration curves. Conclusion The nomogram might be able to preoperatively predict the recurrence of CRSwNP by using currently available and objective parameters. Further studies are required to validate its reliability and effectiveness.

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Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps

Cited by 9 publications

References 29 publications

Impaired small airway function in non‐asthmatic chronic rhinosinusitis with nasal polyps

Impaired small airway function in non‐asthmatic chronic rhinosinusitis with nasal polyps

Endotypes of chronic rhinosinusitis: Relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches

A Nomogram Combing Peripheral Parameters for Estimation of CRSwNP Recurrence

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