Impact of type 2 targeting biologics on acute exacerbations of chronic rhinosinusitis

Abstract

Background: Acute exacerbations of chronic rhinosinusitis (AECRS) are associated with significant morbidity and decreased quality of life. There are sparse data assessing the real-world impact of biologics on AECRS. Objectives: We sought to determine the impact of type 2‐targeting biologics on the frequency of medication use for AECRS episodes. Methods: Antibiotic and/or systemic corticosteroid courses for AECRS were identified in a retrospective study from November 2015 to February 2020, at a single academic health system. The estimated yearly rates for antibiotic and corticosteroid courses were evaluated before and after initiation of type 2 biologics. Results: One-hundred and sixty-five patients with chronic rhinosinusitis (CRS) had received either omalizumab (n = 12), mepolizumab (n = 42), benralizumab (n = 44), dupilumab (n = 61), or reslizumab (n = 6). Seventy percent had CRS with nasal polyps, and 30% had CRS without nasal polyps. All the patients had asthma. When all the biologics were combined, the estimated yearly rate for antibiotics for AECRS decreased from 1.34 (95% confidence interval [CI], 1.12‐1.59) to 0.68 (95% CI, 0.52‐0.88) with biologic use (49% reduction, p < 0.001). Those with frequent AECRS (three or more courses of antibiotics in the 1 year before biologic use) had a larger degree of reduction, with an estimated yearly rate of 4.15 (95% CI, 3.79‐4.55) to 1.58 (95% CI, 1.06‐2.35) with biologic use (n = 27; 62% reduction; p < 0.001). Within the total cohort, the estimated yearly rate for systemic corticosteroids for AECRS decreased from 1.69 (95% CI, 1.42‐2.02) to 0.68 (95% CI, 0.53‐0.88) with biologic use (60% reduction; p < 0.001). Conclusion: Type 2‐targeting biologics reduced medication use for AECRS. This suggested that biologics may be a therapeutic option for patients with frequent AECRS.

Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

“…Some studies have defined an AECRS as any acute worsening of sinonasal symptomatology reported by the patient, 16 whereas others have followed this definition but used quantitative validated patient‐reported outcomes to verify worsening symptomatology 17 . Other studies have used surrogate measures of AECRS to quantify AECRS frequency, such as the frequency of sinus infections and/or frequency of rescue medication (i.e., antibiotics or oral corticosteroids) 2,15,18–21 . Finally, endoscopic findings have also been used to define AECRS in the literature.…”

“…Type 2 cytokines produced during AECRS can mechanically weaken the epithelial barrier and increase permeability, thus leading to a susceptibility for microbial invasion and infection 20,28 . Furthermore, baseline epithelial inflammation in CRS can be exacerbated by viral infections and the subsequent host response, further diminishing epithelial function 29 .…”

“…Prior to the dedicated use of biologics for CRSwNP, however, the impact of biologics on CRS was primarily seen as a secondary benefit in the use of biologics for the treatment of asthma in asthmatic CRS patients. One retrospective study showed that biologic use in a population of CRS patients (both with and without polyps) with comorbid asthma significantly reduced both antibiotic use and oral corticosteroid use for AECRS (49% and 60% reduction, respectively) 20 . In specific patients reporting frequent AECRS (defined as three or more antibiotic courses in the last year), there was a highly significant 62% reduction in antibiotic use for AECRS with the use of biologics 20 .…”

“…One retrospective study showed that biologic use in a population of CRS patients (both with and without polyps) with comorbid asthma significantly reduced both antibiotic use and oral corticosteroid use for AECRS (49% and 60% reduction, respectively) 20 . In specific patients reporting frequent AECRS (defined as three or more antibiotic courses in the last year), there was a highly significant 62% reduction in antibiotic use for AECRS with the use of biologics 20 . Although biologics are not currently approved for CRSsNP, they can be a useful, yet expensive, adjunct in CRSwNP patients and have been shown to reduce AECRS 20,46 .…”

“…In specific patients reporting frequent AECRS (defined as three or more antibiotic courses in the last year), there was a highly significant 62% reduction in antibiotic use for AECRS with the use of biologics 20 . Although biologics are not currently approved for CRSsNP, they can be a useful, yet expensive, adjunct in CRSwNP patients and have been shown to reduce AECRS 20,46 . Recent trials specifically studying the efficacy of biologics for the treatment of CRSwNP have also documented that their use is associated with decreased systemic corticosteroid usage for CRSwNP again suggesting decreased AECRS 46–49 .…”