RESUMO
BACKGROUND: Currently, there is a debate around the use of biological agents in the treatment of chronic sinusitis with nasal polyps. Therefore, this study's purpose was to assess the effectiveness of various biologics in the treatment of chronic rhinosinusitis with nasal polyps. METHODS: A systematic and manual search was conducted for all relevant studies from inception to December 20, 2023. Two independent authors carried out the search, screening, assessment, and data extraction. Network meta-analysis was conducted using STATA 14 software. RESULTS: Our analysis includes a comprehensive set of 19 studies. These studies compared the efficacy of four distinct biologic treatments. The results of reticulated Meta-analysis showed that Dupilumab (MD = - 1.85, 95% CI: - 2.47, - 1.24), Omalizumab (MD = - 1.30, 95% CI: - 1.90, - 0.70), Benralizumab (MD = - 0.84, 95% CI: - 1.66, - 0.03) and Mepolizumab (MD = - 1.48, 95% CI: - 2.22, - 0.74) were superior to placebo from the nasal polyp score(NPS), Dupilumab (MD = - 12.56, 95% CI: - 22.49,- 2.63) was superior to placebo from the Sino-Nasal Outcome Test-22(SNOT-22)score, and Dupilumab (MD = - 0.84, 95% CI: - 1.08, - 0.59) and Omalizumab (RR = - 0.51, 95% CI: - 0.83, - 0.19) were superior to placebo from the nasal congestion severity(NCS). In terms of cumulative sorting under the surface of the curve (SUCRA) values, Dupilumab was the best performer in the NPS (0.92), SNOT-22 score (0.70), and NCS (0.93); Four different biologics outperformed placebo in the NPS, SNOT-22 score, and NCS. CONCLUSION: In patients with CRSwNP, based on the efficacy (NPS, (SNOT-22) score, NCS) and, dupilumab is the most efficacious for CRSwNP.
RESUMO
BACKGROUND: Chronic rhinosinusitis (CRS) is usually accompanied by mucin hypersecretion that can lead to mucus accumulation and impair nasal mucociliary clearance, thus exacerbating airway inflammation. Abnormal mucin hypersecretion is regulated by different T helper (Th) cytokines, which are associated with different endotype-driven inflammatory responses. Therefore, it is of great significance to understand how these factors regulate mucin hypersecretion to provide precise treatment strategies for different endotypes of CRS. BODY: Thus far, the most common endotypes of CRS are classified as type 1, type 2, or type 3 immune responses based on innate and adaptive cell-mediated effector immunity, and the representative Th cytokines in these immune responses, such as IFN-γ, TNF-α, IL-4, IL-5, IL-13, IL-10, IL-17, and IL-22, play an important regulatory role in mucin secretion. We reviewed all the related literature in the PubMed database to determine the expression of these Th cytokines in CRS and the role they play in the regulation of mucin secretion. CONCLUSION: We believe that the main Th cytokines involved in specific endotypes of CRS play a key role in regulating abnormal mucin secretion, which contributes to better understanding of the pathogenesis of CRS and provides therapeutic targets for airway inflammatory diseases associated with mucin hypersecretion.