Efficacy of Biologics on Refractory Eosinophilic Otitis Media Associated with Bronchial Asthma or Severe Uncontrolled CRSwNP

Corso, Eugenio De; Montuori, Claudio; Settimi, Stefano; Mele, Dario Antonio; Cantiani, Alessandro; Corbò, Marco; Cantone, Elena; Paludetti, Gaetano; Galli, Jacopo

doi:10.3390/jcm11040926

Cited by 16 publications

(12 citation statements)

References 31 publications

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“…Eosinophilic otitis media (EOM) was observed in 3/57 of our patients. We noticed a reduction in EOM associated symptoms (evaluated with the Otitis Severity Score proposed by Iino et al [ 21 ] and the Italian validated version of COMOT-15 [ 22 ]) and an improvement in pure tone audiometry-evaluated pure tone average (PTA), as recently published [ 23 ].…”

Section: Resultssupporting

confidence: 56%

Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A “Real-Life” Observational Study in the First Year of Treatment

Corso

Settimi

Montuori

et al. 2022

JCM

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The aim of this study was to evaluate the efficacy of dupilumab in the treatment of severe uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), with or without asthma as add-on therapy with intra-nasal corticosteroids in a real-life setting over the first year of treatment. Our data demonstrated that subcutaneous 300 mg dupilumab administered at home via a pre-filled auto-injector every two weeks, based on indications set by the Italian Medicines Agency, was rapidly effective in reducing the size of polyps, decreasing symptoms of disease, improving quality of life, and recovering olfaction. Significant improvement was observed after only 15 days of treatment, and it progressively increased at 6 and 12 months. Dupilumab was also effective in reducing the local nasal eosinophilic infiltrate, in decreasing the need for surgery and/or oral corticosteroids, and in improving control of associated comorbidities such as chronic eosinophilic otitis media and bronchial asthma. After 12 months of treatment, 96.5% of patients had a moderate/excellent response. From our data, it was evident that there was a group of patients that showed a very early response within one month of therapy, another group with early response within six months from baseline, and a last group that improved later within 12 months. The results of this study support the use of dupilumab as an effective option in the current standard of care for patients affected by severe uncontrolled CRSwNP.

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Section: Resultssupporting

confidence: 56%

Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A “Real-Life” Observational Study in the First Year of Treatment

Corso

Settimi

Montuori

et al. 2022

JCM

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“…This also corresponds with the normalization of eosinophil counts seen in this study after treatment with biologic therapy. The improvement in this subject cohort coheres with several recent smaller studies examining biologic therapies for confirmed eosinophilic otitis media (10–15). These previous studies have all been small series or case reports, but data are accumulating demonstrating improved symptoms in this challenging population.…”

Section: Discussionsupporting

confidence: 82%

“…Eosinophilic otitis media likely falls in this spectrum of diffuse type 2 eosinophilic inflammation, given comorbid asthma and nasal polyposis in the diagnostic criteria (8,9). In small studies and single case reports (10)(11)(12)(13)(14)(15), patients with concomitant otologic disease have improved after initiation of treatment with biologic therapy for their coexistent asthma and nasal polyposis, suggesting a common underlying role for eosinophilia in the manifestations of this disease. The aim of the present study is to compare the response of suspected eosinophilic otitis media to treatment with or without a targeted biologic therapy against IL-4, IL-5, or IL-13 signaling.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy

2023

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ObjectiveTo compare the responses of suspected eosinophilic otitis media to treatment with or without a targeted biologic therapy against interleukin-4 (IL-4), IL-5, or IL-13 signaling.Study DesignRetrospective review.SettingTertiary referral center.PatientsSubjects with type 2 chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and otitis media who underwent treatment between 2005 and 2021.InterventionTreatment with targeted biologic therapy.Main Outcome MeasuresPre- and posttreatment nasal endoscopy, ear examination, and audiologic evaluation.ResultsFour hundred seventy-seven subjects with type 2 CRSwNP were treated between 2005 and 2021. Sixty-two had otitis media with pre- and posttreatment evaluation. Retrospective chart review assessed pre- and posttreatment exam findings, nasal endoscopy, audiometry, and tympanometry. Nineteen subjects received a biologic therapy, whereas 43 did not. Exam, endoscopy, and tympanometry were graded for severity and compared pre- and posttreatment. Subjective ear exam and tympanometry were significantly improved with biologic therapy (control = 0.05, biologic = 0.84, p = 9.3 × 10−5; control = −0.1, biologic = 0.62, p = 0.0002). Conductive hearing loss as assessed by air–bone gaps did not change between groups (control = 1.2 dB better, biologic = 1.2 dB worse, p = 0.32). Nasal endoscopy findings improved with biologic therapy relative to the control group, although not statistically significant (control = 1.04, biologic = 1.36, p = 0.22).ConclusionsBiologic therapies targeting interleukin-4 (IL-4), IL-5, and IL-13 signaling are potential new treatments for eosinophilic otitis media. This is the largest study demonstrating improvement in subjects with suspected eosinophilic otitis media in response to biologic therapy, and immune modulation represents a novel treatment strategy for this challenging condition.Professional Practice Gap and Educational NeedCurrent treatment strategies for otologic symptoms in eosinophilic disease are not tremendously effective or durable, resulting in a need for improved treatment options.Learning ObjectiveTo determine if targeted biologic therapy, often used for eosinophilic asthma and type 2 chronic rhinosinusitis with nasal polyposis, improves coexistent suspected eosinophilic otitis media.Desired ResultTreatment of suspected eosinophilic otitis media with targeted biologic therapy will result in improvement of otologic symptoms with a durable response compared with current treatment options.Level of EvidenceLevel IV.Indicate IRB or IACUCExempt. HUM00182703.

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“…Recent basic science research has led to significant advances in understanding the pathophysiological processes of disease. These processes define the endotype of a disease opening the way for the development of new diagnostic tools and innovative targeted treatments, especially in the rhinologic fields [ 33 , 34 , 35 , 36 , 37 , 38 ]. As has already happened for asthma and CRSwNP, and for many other autoimmune and oncological pathologies, the study of molecular biomarkers might help to develop new potential therapeutic target, and to improve an early diagnosis and a more accurate prognosis.…”

Section: Discussionmentioning

confidence: 99%

Endotyping of Cholesteatoma: Which Molecular Biomarkers? A Systematic Review

Cantone

Nola

Corso

et al. 2022

JPM

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Background: So far, no medical treatment is available for cholesteatoma (C) and the only effective therapy is complete surgical removal, but recurrence is common even after surgical treatment. While C is classically divided into two clinical phenotypes, congenital and acquired, only a few studies have focused on its potential biomarkers. This study aims to revise the literature to identify which biomarkers can define the endotype of C. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process to identify published experimental articles about molecular biomarkers in C. Results: KGF and its receptor, MMP-9, KRT-1, KRT-10, and MIF might be considered biomarkers of recurrence, whereas Ki-67, TLR-4, RANKL, IL17, MMP-2, MMP-9, IL6, TNF-α, should be considered more specifically as biomarkers of bony erosion. Conclusions: These results are interesting especially from a prognostic point of view, nevertheless more studies are needed to search new biomarkers of C that could completely change not only the therapeutic standards of the disease, but also the clinical history of C itself in the era of precision medicine.

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Efficacy of Biologics on Refractory Eosinophilic Otitis Media Associated with Bronchial Asthma or Severe Uncontrolled CRSwNP

Cited by 16 publications

References 31 publications

Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A “Real-Life” Observational Study in the First Year of Treatment

Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A “Real-Life” Observational Study in the First Year of Treatment

Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy

Endotyping of Cholesteatoma: Which Molecular Biomarkers? A Systematic Review

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