Aspirin desensitization for aspirin‐exacerbated respiratory disease in the era of biologics: Clinical perspective

Bosso, John V.

doi:10.1002/alr.22709

Cited by 7 publications

(8 citation statements)

References 15 publications

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“…The price for daily therapy is thus less than $100 per year. For the one-time cost of a desensitisation procedure, the price ranges from $1.700 to $3.000 ( 3 , 33 ). In contrast, the cost of Th2 biological therapy is estimated to be $30.000 to $40.000 per patient per year.…”

Section: From the Perspective Of The Physicianmentioning

confidence: 99%

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Monoclonal antibody or aspirin desensitization in NSAID-exacerbated respiratory disease (N-ERD)?

Broeck

Steelant²,

Scadding³

et al. 2023

Front. Allergy

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Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a clinical syndrome characterized by nasal polyposis, asthma, and intolerance to aspirin/NSAID. It affects approximately 15% cases of severe asthma, 10% of nasal polyps and 9% of rhinosinusitis. N-ERD results in associated asthma exacerbations, oral corticosteroids bursts, corticosteroid-dependent disease, and multiple endoscopic sinus surgeries. Unknown influences cause polyp epithelium to release alarmins, such as IL-33 and TSLP. These cytokines activate lymphoid cells, both Th2 and ILC2, to release cytokines such as IL5, IL4 and IL13, resulting in complex type 2 inflammation involving mast cells, eosinophils and platelets. Arachidonic acid released from such cells is metabolized into mediators. N-ERD is characterized by an imbalance in eicosanoid levels, especially CysLTs, PDG and PGE2. Patients with N-ERD present nasal symptoms (congestion, hyposmia/anosmia, nasal discharge) and lower airways symptoms (cough, sneezing, shortness of breath, chest tightness), anosmia, severe hyposmia as well as severe asthma which impacts the quality of life in this disease and leads to safety concerns in patients daily lives. Despite the variety of treatment strategies, the likelihood of recurrence of symptoms is high in patients with N-ERD. The most important strategies for treating N-ERD are listed as following: drug therapies, aspirin desensitization, monoclonal antibodies and other therapies associated. N-ERD treatment remains a major challenge in the current situation. Selecting the appropriate patient for aspirin desensitization, monoclonal antibodies or both is essential. This review provides an overview on aspirin desensitization and biologics in N-ERD and might help in decision making from both the perspective of the physician and patient. Patient characteristics, safety, efficacy, health care costs, but also patient preferences are all factors to take into account when it comes to a choice between biologics or aspirin desensitization.

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Section: From the Perspective Of The Physicianmentioning

confidence: 99%

“…In contrast, the cost of Th2 biological therapy is estimated to be $30.000 to $40.000 per patient per year. Given the fact that the age of onset of N-ERD is around 30 years and N-ERD is not remitting spontaneously, biological therapy cost multimillion dollars per patient per year ( 3 , 13 , 33 ).…”

Section: From the Perspective Of The Physicianmentioning

confidence: 99%

Monoclonal antibody or aspirin desensitization in NSAID-exacerbated respiratory disease (N-ERD)?

Broeck

Steelant²,

Scadding³

et al. 2023

Front. Allergy

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“…For patients with a contraindication to aspirin therapy, inadequate response to ATAD, or severe asthma refractory to standard management, the use of type 2 (T2) biologics may be considered as salvage therapy. 59 Early evidence for benefit in AERD has been shown with dupilumab (Il-4 receptor alpha subunit antagonist), omalizumab (IgE inhibitor), and mepolizumab (IL-5 inhibitor). [60][61][62][63] However, the cost of these agents remains significant (upwards of $30,000 to $40,000 USD annually), and therefore, it is our opinion that T2 biologics should currently be reserved for ATAD-refractory or intolerant patients, or those with poorly controlled asthma despite standard guideline therapy.…”

Section: Type 2 Biologicsmentioning

confidence: 99%

What's New in the Diagnosis and Treatment of Aspirin-Exacerbated Respiratory Disease: A Brief Review

Douglas

Bosso

2023

Am J Rhinol�Allergy

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Background Aspirin-exacerbated respiratory disease (AERD) is a chronic condition characterized by the presence of asthma, chronic rhinosinusitis with nasal polyposis, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs. Diagnosis is based on careful clinical history and physical examination, characteristic laboratory and radiographic findings, and, in unclear cases, aspirin challenge. Established treatment is founded on comprehensive endoscopic sinus surgery followed by topical steroids and aspirin desensitization. T2 biologics are now available for refractory cases. Objective To summarize the historic literature on AERD, its diagnosis and treatment options, as well as to review the most current publications on the topic and explore areas for future research. Methods A literature review utilizing the PubMed database was performed. Results Seminal journal articles regarding the diagnosis and treatment of AERD were reviewed with close attention to evidence-based protocols and knowledge gaps in the field as areas for future research. Conclusion AERD is a complex disease which requires careful diagnostic work-up and coordinated care between the allergist and rhinologist to facilitate optimal treatment outcomes.

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“…We read with great interest Dr Bosso's recent correspondence. 1 In that communication he nicely describes the emergence of aspirin therapy after desensitization (ATAD), as type 2 biologics represent highly promising therapies in the treatment of our most recalcitrant patients. The rate of surgical revision among patients with aspirinexacerbated respiratory disease (AERD) and other type 2-dominant forms of nasal polyps remain unacceptably high, highlighting our need for these complementary therapies.…”

mentioning

confidence: 99%

“…We read with great interest Dr Bosso's recent correspondence 1 . In that communication he nicely describes the emergence of aspirin therapy after desensitization (ATAD), as type 2 biologics represent highly promising therapies in the treatment of our most recalcitrant patients.…”

mentioning

confidence: 99%

In reply: Aspirin desensitization for aspirin‐exacerbated respiratory disease in the era of biologics: Clinical perspective

Levy

Kuruvilla

2020

Int Forum Allergy Rhinol

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Aspirin desensitization for aspirin‐exacerbated respiratory disease in the era of biologics: Clinical perspective

Cited by 7 publications

References 15 publications

Monoclonal antibody or aspirin desensitization in NSAID-exacerbated respiratory disease (N-ERD)?

Monoclonal antibody or aspirin desensitization in NSAID-exacerbated respiratory disease (N-ERD)?

What's New in the Diagnosis and Treatment of Aspirin-Exacerbated Respiratory Disease: A Brief Review

In reply: Aspirin desensitization for aspirin‐exacerbated respiratory disease in the era of biologics: Clinical perspective

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