AERD Associated Nasal Polyposis: Efficacy of Postoperative Antileukotriene Therapy in Comparison with Aspirin Desensitization. A Retrospective Study

Abstract

Introduction: AERD (aspirin-exacerbated respiratory disease) is a severe form of an inflammatory disease of the upper airway system. Therapy remains challenging due to a complex underlying pathophysiology. Objective: To evaluate the efficacy of postoperative antileukotriene therapy concerning recurrence of nasal polyposis in patients with AERD and to compare it with AD (aspirin desensitization) over time. Methods: In this retrospective study we analyzed AERD patients (N = 61) after functional endoscopic sinus surgery (FESS). Patients were treated at our institution postoperatively with topical mometasone (control group, N = 22), leukotriene-receptor-antagonists (montelukast [MT], N = 18) or underwent an aspirin desensitization (N = 21). Subjective parameters as assessed by SNOT (sinonasal outcome test) questionnaire and endoscopic endonasal examination (polyposis grading) were evaluated throughout a follow-up period of 6-9 and >12 (long-term) months after surgery. Results: Endoscopic endonasal examinations 6-9 months after sinus surgery showed a good disease control in all 3 groups with significant reduction in polyp grading in the AD group. After a follow-up period of more than 12 months, MT and AD patients had significantly less polyp recurrences as compared to the topical treatment group. Subjective sinonasal symptoms revealed that hyposmia and nasal obstruction were prominent factors in all 3 groups throughout the follow-up period. MT group showed significant improvement in sinonasal symptoms over time. Conclusion: Postoperative treatment with leukotriene-receptor-antagonists and aspirin desensitization both significantly reduce nasal polyp recurrence. MT has a positive effect on subjective sinonasal outcomes and patients' quality of life over time.

Central compartment atopic disease: outcomes compared with other subtypes of chronic rhinosinusitis with nasal polyps

“…CRSwNP NOS also demonstrated a higher than expected rate of revision surgery, as well as increased antibiotic prescriptions over other subtypes. Interestingly, AERD, an entity that has also shown recalcitrance in prior reports, 5,24–26 did not demonstrate a significant difference from other CRSwNP subtypes in this study. This is likely due to the smaller sample size of AERD patients, with a higher standard deviation in the data set.…”

Component-Resolved Diagnosis for Endotyping Patients with Chronic Rhinosinusitis with Nasal Polyps

“…In our cohort of patients, atopy is coherently associated to asthma and NERD, as expected, together with other features of type 2 inflammation [29], such as elevated IgE (>100 U/mL) and/or hypereosinophilia (>250 cell/ mmol) [1]. We also identified a high percentage of associated comorbidities, together with elevated type 2 inflammation, in severe not controlled CRSwNP.…”

Transcriptome Analysis Identifies Doublesex and Mab-3 Related Transcription Factor (DMRT3) in Nasal Polyp Epithelial Cells of Patients Suffering from Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease (AERD)

“…To date, however, the role of TP63 in nasal polyps remains to be shown. Interestingly, surgical removal of nasal polyps improves asthma symptoms and decreases urinary LTE 4 levels [8,30]. Thus, the development of new drugs that neutralise this gene may antagonise nasal polyp formation and reduce asthma symptoms.…”