Chronic rhinosinusitis and omalizumab: eosinophils not IgE predict treatment response in real-life

Abstract

Background: Chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP respectively) can be difficult to treat and biologics offer potential as a future therapeutic intervention. CRS and severe asthma often co-exist. Omalizumab is currently licenced for the treatment of severe allergic asthma. Objective: The aim was to determine which blood biomarkers and treatment variables were associated with clinical response for sinonasal symptoms in patients with allergic CRSsNP and CRSwNP who were treated with omalizumab for severe allergic asthma. Methods: Sinonasal outcome test (SNOT)-22 scores were recorded in a cohort of patients with allergic CRSsNP (n=10) or CRSwNP (n=15) treated with omalizumab for severe asthma according to UK guidelines. Using a linear modelling approach, the improvement in the SNOT-22 score as the treatment variable against several disease and treatment predictor variables was modelled. Results: SNOT-22 significantly decreased with omalizumab treatment. Increased blood eosinophil count and omalizumab dosing every two weeks (as opposed to every 4 weeks) were associated with greater reductions in SNOT-22 after 16 weeks of omalizumab treatment. Conclusion: Our study confirms that omalizumab is an effective treatment for CRS, and suggests that improvements are greater in those with eosinophilic disease. Further studies are required to determine long term efficacy and whether this treatment could reduce the need for surgery.

<p>Chronic Rhinosinusitis with Nasal Polyps: Targeting IgE with Anti-IgE Omalizumab Therapy</p>

“…Reduction in blood eosinophils has also been demonstrated following omalizumab therapy in CRSwNP. 45 Other off-label use of omalizumab in various "nonallergic" conditions has found similar findings with respect to clinical improvements. Similar to observations in allergic asthma, reductions in the numbers of blood and tissue eosinophils were reported in patients with eosinophilic gastroenteritis following omalizumab treatment.…”

“…Our own group analysed what factors predicted CRS clinical response in a real-life study. 45 Here, all patients had severe asthma, were sensitised to at least one perennial aeroallergen and had a median eosinophil count of 0.45 x 10 9 /L. Importantly, 75% patients had NERD and therefore represented the more severe, difficult to treat CRSwNP subtype.…”

“…Using a linear modeling approach, we showed that it was the serum eosinophil count and more frequent two weekly omalizumab dosing frequency, not the serum IgE level that predicted treatment response with omalizumab. 45 Interestingly, blood eosinophil counts not IgE also predict better clinical response in asthma with omalizumab. 59,60 Twice weekly omalizumab is more effective in urticaria.…”

Chronic rhinosinusitis with and without nasal polyps and asthma: Omalizumab improves residual anxiety but not depression

“…We have previously shown that omalizumab treats CRS and asthma together in this group of patients 26 ,. 27 As far as we are aware, this is the first real‐life extension study to show that treatment with omalizumab in patients with CRS and severe asthma significantly improved anxiety but had no impact on depression. This was despite improvements in all measures of upper and lower airway disease control.…”

Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis

“…Both small studies (<30 patients) did not show impact on disease-specific QoL, but one study did show effect on the physical domain of short form-36 (SF-36) and asthma quality of life questionnaire (AQLQ), CRS symptom scores, and nasal polyp score [77]. A small real-life study showed that improvements are greater in those with eosinophilic disease and not based on IgE [80].…”