RESUMO
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.
Assuntos
Asma , Produtos Biológicos , Pólipos Nasais , Otite Média com Derrame , Rinite , Sinusite , Humanos , Asma/complicações , Asma/tratamento farmacológico , Asma/epidemiologia , Otite Média com Derrame/complicações , Otite Média com Derrame/diagnóstico , Produtos Biológicos/uso terapêutico , Pólipos Nasais/complicações , Pólipos Nasais/tratamento farmacológico , Estudos Retrospectivos , Sinusite/complicações , Sinusite/tratamento farmacológico , Doença Crônica , Fatores Biológicos/uso terapêutico , Rinite/complicações , Rinite/tratamento farmacológico , Rinite/epidemiologiaRESUMO
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.