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

Abstract

Background Chronic rhinosinusitis (CRS) has a high prevalence of anxiety and depression. It is currently uncertain if treatment in patients with CRS with or without nasal polyps (CRSwNP and CRSsNP) has any impact on improving mental health outcomes. The aims here were to document anxiety and depression in patients with severe CRS and asthma already treated with appropriate medical therapy. We then evaluated whether further maximal treatment with omalizumab improved anxiety and/or depression alongside improvements in CRS and coassociated asthma. Methods Hospital Anxiety and Depression Scale (HADS) scores along with measures of CRS and asthma severity were recorded according to CRSwNP and CRSsNP status in n = 95 patients with severe CRS and asthma. Of this group, a further n = 23 had omalizumab for associated allergic asthma. Follow‐up measures were collected 16 weeks after omalizumab treatment. Results HADS anxiety and depression prevalence in CRS were 49.47 % and 38.95%, respectively. Within the CRSwNP and CRSsNP group 53.06% and 45.66% had raised HADS‐anxiety scores. Abnormal HADS‐depression scores were present in 40.82% and 36.95% of the CRSwNP and CRSsNP groups, respectively. Correlations for sinonasal outcome test‐22 (SNOT‐22) versus HADS total was r = 0.59 p < 0.0001, HADS‐anxiety r = 0.56 p < 0.0001 and HADS‐depression r = 0.49 p < 0.0001. Omalizumab improved anxiety in CRS (p < 0.0001) regardless of nasal polyp status (CRSwNP p = 0.0042 and CRSsNP p = 0.0078). Depression scores did not improve in either group. SNOT‐22 (p = 0.0006), asthma control questionnaire‐7 (p = 0.0019) and mini‐asthma quality of life questionnaire including emotional function (p = 0.0003 and p = 0.0009, respectively) all improved in both subgroups. Conclusion In CRS and asthma, anxiety scores but not depression improved after omalizumab treatment. Anxiety may be closely related to airway disease severity, but depression may be independent of airway disease itself. If so, a separate mental health care pathway is needed for CRS patients with depression.

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study

“…In patients who were diagnosed with CRSwNP, we observed a higher HADS score than both CRSsNP and SD, regardless of age subgroups (Table 4). This difference reflects what has already been published in the literature, being consistent with recent research by Vogt et al, who reported a slightly higher prevalence of anxiety (53.06% vs 45.66%) and depression (40.82% vs 36.95%) stratifying CRS patients by the presence of nasal polyps [31]. Notably, this is the first reported series comparing HADS scores within CRSw/sNP and SD groups.…”

Influence of effective omalizumab treatment on eosinophils in allergic asthma with comorbidities

“…Additionally, such results that omalizumab improved anxiety alongside improvements in asthma were also found in chronic rhinosinusitis 34 and chronic spontaneous urticaria 35 treated with omalizumab.…”

Prevalence and predictors of depression and anxiety in patients with chronic rhinosinusitis: a systematic review and meta-analysis

“…Among the 32 studies (n=56 933), 32 reported the prevalence of depression symptoms and 12 reported the prevalence of anxiety symptoms. The 32 samples were from the USA (n=17),3 7–22 the UK (n=3),23–25 Canada (n=3),26–28 Korea (n=4),29–32 China (n=3),33–35 Egypt (n=1),36 and Sweden (n=1) 37. Seven studies reported the prevalence of depression symptoms in men (n=551) and women (n=644); 11 studies reported the prevalence of depression symptoms in patients with CRSwNP (n=6135) and CRSsNP (n=11 697).…”