RESUMEN
Background: Chronic rhinosinusitis with nasal polyps (CRSwNPs) is associated with otitis media with effusion (OME) in about 25% of cases. The objective of this study was to assess the clinical efficacy of the 4 biologic agents currently available in France for severe asthma (omalizumab, mepolizumab, benralizumab and dupilumab) in 17 patients followed for both asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) and presenting otitis media with effusion (OME) on otoscopy. Methods: It was a multicenter retrospective study performed in 4 academic ENT and respiratory departments in Paris, France, with assessment of the clinical evolution of 17 patients with severe eosinophilic asthma and with chronic refractory OME and CRSwNPs treated by biologic agents. Global evaluation of treatment effectiveness (GETE) on asthma, CRSwNP and OME was classified on a 5-point scale as 1, excellent; 2, good; 3, moderate; 4, poor; or 5, symptoms worsening. Response was defined as an excellent/good score (1 or 2). Results: 17 patients were prescribed a total of 30 biologics. The evolution of OME did not follow that of asthma and CRSwNPs in 15 (88%) and 12 (70%) cases, respectively. Concerning OME, 19/30 (63%) patients were non-responders. Among the 10 patients who successively received ≥ 2 biologic agents, the OME response differed, depending on the considered agent Dupilumab had the highest response rate. Conclusions: Resistant OME, associated with asthma and chronic rhinosinusitis with nasal polyps, can present a disconnected evolution under biologics. CRSwNP-associated OME requires a specific evaluation to define the best treatment.
Asunto(s)
Asma , Productos Biológicos , Pólipos Nasales , Otitis Media con Derrame , Rinitis , Sinusitis , Humanos , Asma/complicaciones , Asma/tratamiento farmacológico , Asma/epidemiología , Otitis Media con Derrame/complicaciones , Otitis Media con Derrame/diagnóstico , Productos Biológicos/uso terapéutico , Pólipos Nasales/complicaciones , Pólipos Nasales/tratamiento farmacológico , Estudios Retrospectivos , Sinusitis/complicaciones , Sinusitis/tratamiento farmacológico , Enfermedad Crónica , Factores Biológicos/uso terapéutico , Rinitis/complicaciones , Rinitis/tratamiento farmacológico , Rinitis/epidemiologíaRESUMEN
Focal bronchial dilatations develop after bronchial thermoplasty (BT) in 58% of patients with severe asthma. This suggests a need for systematic evaluation by CT scan after BT, with specific focus on bronchial dilatation development. https://bit.ly/2AYuhMj.