Predictive factors for identifying macrolide responder in treating chronic rhinosinusitis

Abstract

BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders. METHODOLOGY: A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤5, and no rescue medication. RESULTS: One hundred CRS patients (mean age 47.4±14.1 years, 45% male) were enrolled. Univariable logistic regression showed local total IgE less than 5.21; and serum eosinophils less than 2.2% associated with macrolide response. Multivariate models showed local total IgE maintained an independent association with macrolide response, with an ability to discriminate between responders and non-responders of 63%. Serum total IgE, nasal secretion IL-5, serum neutrophil, nasal polyp, asthma, allergy, and aspirin hypersensitivity showed no association with LDM response. CONCLUSIONS: Low total IgE level in the nasal secretion but not in the serum, predict LDM response.

Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial

“…12 Seresirikachorn reported that low total IgE levels in the nasal secretion but not in the serum predict macrolides response in a prospective cohort study. 25 The key point is whether systemic allergy test results could reflected the local anaphylaxis in patients with CRS. Du et al identified a relationship between type-2 inflammation biomarkers (EOS and IgE) in polyp tissue and those in blood, of which the r values were 0.423 and 0.530.…”

Change in eosinophil biomarkers after full‐house endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps

“…Serum and nasal secretion samples were collected twice (1) at the baseline, and (2) at 4 weeks after surgery for the study group or 4 weeks after the enrollment for the control group. Nasal secretion samples were obtained using the methods described by a previous study 4 . Study outcomes in this study were measured at the 4‐week time frame after postinjury inflammation had subsided.…”

“…Nasal secretion samples were obtained using the methods described by a previous study. 4 Study outcomes in this study were measured at the 4-week time frame after postinjury inflammation had subsided. Corticosteroids were not allowed during this period to avoid confounding effects.…”

Neutrophilic inflammation in chronic rhinosinusitis

“…Multiple studies reported that the presence of neutrophils in subepithelial regions of nasal polyps is associated with refractory CRS [65][66][67][68][69]70 ]. Markers of severe or moderate neutrophilic inflammation were associated with elevated levels of IL-8 and high proportions of difficult to treat CRS [71].…”