Surgical outcomes in aspirin‐exacerbated respiratory disease without aspirin desensitization

Grose, Elysia; Lee, Dong Hoon; Yip, Jonathan; Cottrell, Justin; Sykes, Jenna; Lee, Jason K.; Lee, John M.

doi:10.1002/alr.22626

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…Similarly, in our study with a mean follow up time of approximately 10 months, only one patient required revision ESS and only after stopping dupilumab therapy due to an adverse reaction. The ability to reduce or delay the need for ESS and subsequent revision surgeries is an important consideration in this patient population who have a high propensity for multiple surgical interventions, particularly among patients with AERD [ 25 ]. This study had a large proportion of patients with AERD (41%) and further demonstrates effectiveness in this difficult-to-treat patient population in the real world setting.…”

Section: Discussionmentioning

confidence: 99%

“…The delay in initiating therapy with dupilumab is likely secondary to a multitude of factors including the fact that patients typically have improvement from surgery for approximately 1 year prior to seeking additional therapy in addition to insurance approval delays for obtaining the medication. 25 Additionally, the validity of this study is limited by its relatively small sample size of patients. Despite the limitations described here, our study suggests that in this cohort of patients, dupilumab treatment improves sinonasal symptoms and quality of life in patients with difficult-to-treat and medically refractory CRSwNP.…”

Section: Limitationsmentioning

confidence: 96%

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Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice

Grose¹,

Li²,

Lee³

2023

Allergy Asthma Clin Immunol

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Background In 2020, dupilumab became the first monoclonal antibody therapy to be approved by Health Canada for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). The primary aim of this study was to characterize the outcomes in an initial cohort of patients with CRSwNP who have undergone dupilumab therapy. Methods A retrospective study was conducted of patients with CRSwNP who were treated with dupilumab. Demographic information, comorbidities, number of previous surgeries, and insurance information were collected. The primary outcome were changes in the sinonasal outcome test (SNOT-22) scores from baseline to timepoints after receiving dupilumab. Results Forty-eight patients were considered for dupilumab therapy, and 27 (56%) received coverage or were able to fund the medication independently. Patients waited an average of 3.6 months to obtain access to the medication. The mean age of the patients was 43. Forty-one percent (11/27) of patients had aspirin exacerbated respiratory disease, and 96% (26/27) had a diagnosis of asthma. The mean length of time on dupilumab was 12.1 months. The baseline SNOT-22 score was 60.6. The mean decrease at 1 month, 3 months, 6 months, and 12 months after starting dupilumab was 8.8, 26.5, 42.8, and 33.8, respectively. There were no serious adverse events. Conclusion Patients treated with dupilumab in a Canadian tertiary care rhinology clinic demonstrated substantial clinical improvement as measured by disease-specific sinonasal outcomes. Further studies are needed to determine the longer-term effectiveness and adverse event profile of this novel therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 96%

Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice

Grose¹,

Li²,

Lee³

2023

Allergy Asthma Clin Immunol

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“…If possible, surgeons managing AERD patients should be comfortable performing advanced aeration surgical procedures. Advanced aeration surgery such as Draf III has, in the setting of AERD, have been shown to have positive outcomes including greater quality of life, improved disease maintenance, and reduced polyp recurrence [ 78 , 79 ]. There is additional data that has emerged that complete sinus surgery followed by aspirin desensitization and long-term aspirin maintenance leads to long-term symptom disease control [ 80 , 81 ].…”

Section: Discussionmentioning

confidence: 99%

Canadian multidisciplinary expert consensus on the use of biologics in upper airways: A Delphi study

Thamboo

Lee

Bhutani

et al. 2023

Journal of Otolaryngology - Head & Neck Surgery

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Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ($$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract

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“…Some AERD patient's polyps will reform as quickly as a few months after surgery [6,35]. More recent studies looking at CRSwNP and/or AERD patients noted 45-90% of them required recurrent surgery, some of this variability includes mixed population of patients (not just AERD patients), variable follow-up (18 months vs 5 years), and geographic variations [36,37]. A 2007 meta-analysis study found 40% of patients with CRSwNP had reoccurrence of polyps at 18months but did not look at AERD specifically [38].…”

Section: Functional Endoscopic Sinus Surgerymentioning

confidence: 99%

“…Two studies looked at AERD specific patients, Grose et al found in a retrospective study probability of remaining free of revision surgery: 98.2% at one year, 78.8% at 3 years and 44.8% at 5 years. In that cohort 16 patients were also placed on monoclonal antibody therapy (omalizumab, mepolizumab, or both) [37]. One study showed a 5 year rate of polyp free symptoms of only 10% in AERD patients vs 84% CRSwNP but NSAID tolerant [36].…”

Section: Functional Endoscopic Sinus Surgerymentioning

confidence: 99%

Updates on treatment options in aspirin exacerbated respiratory disease

Ramos

Woessner

2021

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewThe aim is to describe why this review is timely and relevant. Acetylsalicylic acid exacerbated respiratory disease (AERD) is a clinically significant disease affecting approximately 7% of all asthmatics or around 1,400,000 persons in the United States alone. A large portion of these patients remain undiagnosed. This review summarizes up to date knowledge on the pathophysiology, treatment opinions and provides an expert opinion on how to approach the AERD patient. Recent findingsFindings describe the main themes in the literature covered by the article. Review of the current knowledge in terms of the key cells, cytokines/chemokines contributing to the acquired disease state of AERD. It also provides clinical approach toward the AERD patient with regards to current treatment options.

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Surgical outcomes in aspirin‐exacerbated respiratory disease without aspirin desensitization

Cited by 6 publications

References 27 publications

Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice

Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice

Canadian multidisciplinary expert consensus on the use of biologics in upper airways: A Delphi study

Updates on treatment options in aspirin exacerbated respiratory disease

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