Long-term Clinical Outcomes of Aspirin Desensitization With Continuous Daily Aspirin Therapy in Aspirin-exacerbated Respiratory Disease

Abstract

Background Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad or aspirin (ASA)-intolerant asthma, affects 7% of asthmatics and has a higher prevalence in those with chronic rhinosinusitis and concomitant nasal polyposis. ASA desensitization with daily ASA therapy is a uniquely beneficial treatment for this disease entity and has been shown to have a significant impact on symptom scores, polyp disease, and need for systemic corticosteroids. However, no long-term studies have demonstrated whether or not ASA therapy remains safe and beneficial for these patients beyond 5-10 years. Objective This study was designed to determine the clinical course of AERD patients desensitized between 1995 and 2010. Methods A 20-question survey was distributed to patients who successfully completed ASA desensitization between January 1995 and April 2010. The questions were designed to assess ASA safety and longitudinal effects of ASA therapy in AERD. Results Of the 285 patients contacted, 92 (32%) completed the questionnaire. Average length of follow-up was 15 years. Of survey responders, 35 patients had discontinued ASA therapy. Although adverse reactions occurred, many also discontinued due to lack of efficacy or need for surgery. For those remaining on ASA (62%), significant improvement in sense of smell, asthma, sinus, and allergic rhinitis scores were noted ( P ≤ .001). The majority of ASA patients (68%) had a positive response to treatment and did not require further sinus surgery. However, ASA therapy did not delay the time to next sinus/polyp surgery ( P = .27) or reduce total number of sinus surgeries ( P = .56) compared to those who stopped treatment. Nearly 85% of AERD patients on ASA therapy found it to be helpful in improving airway disease and quality of life. Conclusion Aspirin desensitization followed by daily maintenance ASA therapy appears to be safe and effective even after 10+ years of continuous use.

Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis

“…It is also important to note that the follow‐up period in the cardiovascular literature ranges from 3 to 10 years with much larger patient populations . In AERD literature, although observational studies with variable follow‐up periods up to 8 years have not demonstrated significant bleeding risk as portrayed in cardiovascular literature, they demonstrate a high discontinuation rate up to 38% due to side effects such as gastritis and easy bruising . Considering that aspirin desensitization in AERD involves a significantly higher daily dose of aspirin (650 to 1300 mg daily) than what is typically used for cardiovascular protection, the benefits of aspirin desensitization should be closely weighed against the potentially significant adverse effects, GI side effects, and hemorrhage.…”

Endoscopic sinus surgery improves aspirin treatment response in aspirin‐exacerbated respiratory disease patients

“…Aspirin desensitization and daily maintenance therapy benefits many patients with AERD. 3,7 Aspirin therapy has been shown to impart a long-term benefit of polyp regrowth reduction, improved sense of smell, and need for revision sinus surgery in prospective clinical trials. 6,[18][19][20] In addition to aspirin therapy, ESS has been shown to improve the disease process in both physician-reported (nasal endoscopy and Lund-Mackay [LM] computed tomography scores) and patient-reported (SNOT-22 score) measures.…”

“…6 Aspirin desensitization followed by daily maintenance appears to be safe and effective in improving airway disease and quality of life even after 10 or more years of continuous use. 7 Although ESS enhances aspirin treatment response in patients with AERD when performed 3-6 weeks before initiation of aspirin desensitization and treatment, 8 there is insufficient research on aspirin desensitization outcomes with and without antecedent ESS. In addition, aspirin seems to benefit some patients, even if surgery timing was not accounted for or if ESS was performed >12 months before start of aspirin treatment.…”

Effects of omega‐3 fatty acids and aspirin on Porphyromonas gingivalis‐induced periodontitis in rats

“…Fish oil, the main source of omega‐3 polyunsaturated fatty acid, includes eicosapentaenoic acid and docosahexaenoic acid, which have been shown to have anti‐inflammation and protective actions in cardiovascular disease, rheumatoid arthritis, cystic fibrosis, and periodontitis . Treatment with omega‐3 fatty acid has been shown to significantly decrease osteoclast levels and osteoclastic activity related to bone resorption in rats …”

“…12,13 Treatment with omega-3 fatty acid has been shown to significantly decrease osteoclast levels and osteoclastic activity related to bone resorption in rats. 14,15 So far, many different drug classes have been found to be host-modulation agents, including non-steroidal antiinflammation drugs (NSAIDs). 16 NSAIDs are one of the most useful drugs in dentistry because they can stimulate the alveolar bone formation, or prevent the progression of alveolar bone loss in periodontitis.…”