Azithromycin for chronic eosinophilic rhinosinusitis with nasal polyp: a placebo-controlled trial

Abstract

BACKGROUND: Chronic eosinophilic rhinosinusitis with nasal polyps (CRSwNP eosinophilic) is characterised by the formation of benign and bilateral nasal polyps. We aimed to compare the effectiveness of azithromycin as an immunomodulator with the use of a placebo in patients presenting with CRSwNP concomitant with asthma and aspirin intolerance after 3 months of treatment and at a 1-year follow-up. METHODOLOGY: We performed a randomised, double-blind, placebo-controlled trial. Patients received 500 mg azithromycin orally three times/week for 12 weeks. Improvement was evaluated by staging, the Sino-Nasal Outcome Test (SNOT-22), and nasal polyp biopsy. Data collected at pretreatment and 3 months posttreatment were compared. Quality of life was evaluated at the 1-year follow-up. RESULTS: Twenty-seven and 21 patients were treated with azithromycin and a placebo, respectively. The medication was well tolerated overall. Twenty patients (74%) in the azithromycin group and three patients (14%) in the placebo group were not refer- red for surgery at the end of the 3-month treatment. Regarding subjective improvement, there was a median decrease only in the azithromycin group, and the between-group difference was significant. SNOT-22 improvement was maintained in the azithromy- cin group at the 1-year follow-up. CONCLUSIONS: Azithromycin could be considered a therapeutic option for patients presenting with CRSwNP concomitant with asthma and aspirin intolerance.

Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era

“…Antibiotics such as azithromycin and doxycycline are occasionally used in CRSwNP treatment. [100][101][102][103][104] Because of limited evidence, the use of leukotriene receptor antagonists (eg, montelukast) is not recommended. 2,105 Our search results include studies showing significant improvements in QoL after medical therapy, including consistent short-term efficacy with intranasal corticosteroids (spray, drops, or exhalation delivery systems) 106 and oral corticosteroids (Table EI).…”

Outcome measures for chronic rhinosinusitis with nasal polyps

“…Both macrolides and doxycycline are presumed to have treatment effects for CRSwNP through anti-inflammatory mechanisms, which is supported by their observed modulation of inflammatory mediators (351,353) . Macrolides, which have been shown to reduce CRSwNP symptoms and reduce nasal polyp size (354,355) , have been shown to impact both eosinophilic and neutrophilic biomarkers. For example, studies have found significantly lower eosinophil cationic protein (ECP) in nasal secretions in those treated with oral clarithromycin daily for 8 to 24 weeks compared with no antibiotics (356,357) .…”

The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis

“…Aspirin or nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (AERD/NERD) is characterized by asthma, CRSwNP, and aspirin or nonsteroidal anti-inflammatory drug intolerance [90]. In AERD patients with eosinophilic nasal polyps (>40% eosinophils), LDLT azithromycin treatment significantly reduced symptoms (visual analog scale and SNOT-22) and the need for surgery (74% versus 14%) compared to placebo [75]. In addition, another study showed that azithromycin significantly improved disease clearance in AERD patients compared to placebo [73].…”