Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial

Lourijsen, Evelijn; Reitsma, Sietze; Vleming, Marleen; Hannink, Gerjon; Adriaensen, Gwijde Flavius Jacobus Petrus Maria; Cornet, Marjolein; Hoven, Dinand Rienk; Videler, W J M; Bretschneider, Jochen H.; Reinartz, Susanne M.; Rovers, Maroeska M.; Fokkens, Wytske J.

doi:10.1016/s2213-2600(21)00457-4

Cited by 58 publications

(40 citation statements)

References 23 publications

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“…Overall, there is substantial evidence that the current SoC does not lead to satisfactory improvements in clinical outcomes, particularly QoL, which highlights an important unmet need for treatment in CRSwNP. 24 Lack of such evidence has led decisionmakers to an inadequate assessment of the severity and impact of this condition.…”

Section: Conclusion and Key Pointsmentioning

confidence: 99%

“…2 In a recently published multicenter, randomized controlled trial (RCT) comparing patients given ESS and medical treatment (n ¼ 118) with those who received medical treatment alone (n ¼ 116), more than half of all patients had uncontrolled disease at 12 months with either treatment approach, using HR-QoL as the primary outcome measure. 24 This important study provides important evidence of the unmet need for treatment.…”

Section: Introductionmentioning

confidence: 99%

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Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era

Mullol

Azar

Buchheit

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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Section: Conclusion and Key Pointsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era

Mullol

Azar

Buchheit

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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“…In a recent randomized control trial, evaluating ESS and medical therapy for CRS compared to medical therapy alone, fewer patients in the ESS plus medical therapy group experienced AECRS. Furthermore, the ESS plus medical therapy group used less than half of the cumulative mean dose of systemic corticosteroids as the medical therapy group 45 …”

Section: Impact Of Treatment Of Crs On Aecrsmentioning

confidence: 99%

“…Furthermore, the ESS plus medical therapy group used less than half of the cumulative mean dose of systemic corticosteroids as the medical therapy group. 45 Type 2 inflammation is one of the dominant etiologies of CRS in North America and Western Europe. Biologics, consisting of monoclonal antibodies, targeting type 2 inflammation are now approved by United States Food and Drug Administration for the treatment of CRSwNP, although their use for type-2 CRSsNP may be on the horizon.…”

Section: Impact Of Treatment Of Crs On Aecrsmentioning

confidence: 99%

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Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

Walters

Sedaghat

Phillips

2022

Laryngoscope Investig Oto

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Objectives: Acute exacerbations of chronic rhinosinusitis (AECRS) are distinct from baseline symptomatology related to chronic rhinosinusitis (CRS). In this review, we seek to examine the literature on AECRS to synthesize the definition, epidemiology, pathophysiology, treatment, and impact of AECRS on CRS patients.Methods: A comprehensive narrative review of the scientific literature, identified by searching PubMed from inception through April 2022, was performed.Results: AECRS is defined in consensus guidelines as a worsening of chronic sinus disease symptomatology, with a return to baseline, typically after intervention with systemic antibiotics and/or corticosteroids. The working definition used across the literature, however, is broad and heterogeneous. The pathophysiology of AECRS is incompletely understood but is hypothesized to include an interplay of environmental and patient-specific factors. AECRS have been found to have a negative impact on quality-of-life measures, independent of baseline CRS symptomatology, and impact how patients and physicians view overall disease control. Treatment for AECRS includes oral antibiotics and systemic corticosteroids, although their efficacy for AECRS is unclear. Appropriate use of medical and surgical treatment for CRS can reduce the frequency of AECRS.Conclusions: AECRS are a distinct entity in CRS patients and should be independently assessed when evaluating patients for CRS control. The efficacy of systemic medication usage for AECRS is currently unclear, but appropriate medical management of baseline CRS can reduce the frequency of AECRS. More research is needed to further understand this phenomenon, including a more precise and prospective definition, defined epidemiology, and how to appropriately treat.

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Association of cytokine profile with prior treatment failure and revision surgery in chronic rhinosinusitis

Longino

Labby

et al. 2022

Int Forum Allergy Rhinol

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Background Inflammatory patterns in chronic rhinosinusitis (CRS) may predict disease severity, need for multiple sinus surgeries, and treatment response. This study analyzes nasal mucus inflammatory cytokine patterns in patients with (CRSwNP) and without (CRSsNP) nasal polyposis and their association with revision sinus surgery. Methods A total of 319 CRS patients who underwent sinus surgery were included. Cytokines were quantified in intraoperative mucus specimens using a multiplex flow cytometric bead assay. Cytokine expression patterns in patients with 0, 1, and ≥2 previous surgeries were analyzed using Kruskal‐Wallis and principal component (PC) regression analyses. Results There were 122 (38%) patients with CRSsNP and 197 (62%) with CRSwNP. On univariate analysis, interleukin (IL)‐1β, IL‐6, IL‐8, and IL‐21 were associated with increasing number of sinus surgeries in CRSsNP, as were IL‐2, IL‐4, IL‐5, IL‐6, IL‐9, IL‐17A, and tumor necrosis factor (TNF)‐α in CRSwNP. PC analysis with continuous Poisson regression in CRSwNP demonstrated that high IL‐5 and IL‐13 and low IL‐1β, IL‐12, and IL‐21 were associated with more prior surgeries. In CRSsNP low IL‐13 and high IL‐5 and regulated‐on‐activation, normal T‐cell–expressed and secreted (RANTES) were associated with more prior surgeries. Age remained a significant covariate in the full regression model for CRSsNP, but was nonsignificant in CRSwNP. Conclusion In CRSwNP, elevated IL‐5 and IL‐13 levels were higher at time of surgery in patients with more prior surgeries. Type 2 cytokines in CRSsNP demonstrated mixed associations with revision surgery. For both phenotypes, IL‐10, IL‐12, and IL‐21 were consistently lower as number of prior surgeries increased, suggesting that treatment‐resistant disease may be modulated by impairment in these signaling pathways.

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Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial

Cited by 58 publications

References 23 publications

Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era

Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era

Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

Association of cytokine profile with prior treatment failure and revision surgery in chronic rhinosinusitis

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