Quality of life in CRSwNP: evaluation of ACCESS and Lund–Mackay computed tomography scores versus the QoL questionnaire

SUMMARY Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients’ immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.

show abstract

“…It is hard to interpret the answers for cases when ACCESS is used (Q56 s.f.) because of the paucity of responses 49 .…”

Section: Results and Practical Recommendationsmentioning

confidence: 99%

Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics

Corso

Pipolo

Cantone³

et al. 2023

Acta Otorhinolaryngol Ital

View full text Add to dashboard Cite

show abstract

“…Despite medical treatments, recurrent ESS is required in CRSwNP patients, which significantly reduces the QoL [ 8 , 11 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye

Demir,

Tunakan Dalgic,

Mete Gokmen

et al. 2024

Medicina

View full text Add to dashboard Cite

Background and Objectives: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms, as well as endoscopic and tomography scores. Our secondary goal is to show a reduction in the frequency of acute sinusitis exacerbations and the need for surgery. Materials and Methods: We conducted a multicenter, retrospective, real-life study. We screened the patients with asthma-comorbid CRSwNP treated with omalizumab or mepolizumab. A total of 69 patients (40 F/29 M; omalizumab n = 55, mepolizumab n = 14) were enrolled. We compared the visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), nasal congestion score (NCS), Lund–Mackay computed tomography score (LMS), and total endoscopic polyp scores (TPS) before and after BAs. We evaluated the endoscopic sinus surgery (ESS) and acute exacerbations of chronic rhinosinusitis (AECRS) frequencies separately, according to the BAs. Results: The overall median (min–max) age was 43 (21–69) years. The median (min–max) of biologic therapy duration was 35 (4–113) months for omalizumab and 13.5 (6–32) for mepolizumab. Significant improvements were seen in VAS, SNOT-22, and NCS with omalizumab and mepolizumab. A significant decrease was observed in TPS with omalizumab [95% CI: 0–4] (p < 0.001), but not with mepolizumab [95% CI: −0.5–2] (p = 0.335). The frequency of ESS and AECRS were significantly reduced with omalizumab [95% CI: 2–3] (p < 0.001) and [95% CI: 2–5] (p < 0.001); and mepolizumab [95% CI: 0–2] (p = 0.002) and [95% CI: 2–8.5] (p < 0.001), respectively. There was no significant difference in LMS with either of the BAs. Conclusions: Omalizumab and mepolizumab can provide a significant improvement in the sinonasal symptom scores. BAs are promising agents for CRSwNP patients with frequent exacerbations and multiple surgeries.

show abstract

“…Our study design primarily focused on measuring improvements in QoL of patients suffering from CRSwNP, as reflected in both SNOT-22 scores and subjective expressions by our patients. This is due to evidence that improvement in disease-specific health-related QoL outcomes does not necessarily correlate with endoscopic examination [19], eosinophilic status [16], nasal polyp status [18], histopathology [17], or radiologic score [20]. Therefore, we included patients who missed their follow-up visits as well, all of whom expressed significant satisfaction from their symptoms' relief and improvement in QoL.…”

Section: Discussionmentioning

confidence: 99%

“…Since the main goal of biological therapy for CRSwNP is the improvement in quality of life (QoL), which is often assessed through patients' subjective statements and by validated QoL questionnaires, such as the Sino-Nasal Outcome Test 22 (SNOT-22) [15]. We chose to focus mainly on the SNOT-22 and on subjective statements rather than on radiologic or endoscopic findings based on evidence regarding no correlation between symptoms' relief and radiologic or endoscopic findings [16][17][18][19][20]. In addition to our preliminary study, a national multicenter study is expected to commence soon.…”

Section: Of 10mentioning

confidence: 99%

Biological Treatment for Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: Preliminary Real-World Results from a Tertiary Medical Center

Book

Eligal

Tal

et al. 2023

JCM

View full text Add to dashboard Cite

The efficacy of biological treatment for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) has recently been demonstrated through double-blinded clinical trials. The aim of this study was to provide preliminary real-world experience regarding biological therapy for uncontrolled CRSwNP. The records of patients who received biological treatment in a tertiary medical center between the years 2019 to 2022 were retrospectively reviewed. Patients included in this study were eligible for biological treatment according to the EPOS 2020 criteria. Among patients who had their first follow-up visit <6 months from the treatment initiation, the Sino-Nasal Outcome Test 22 Questionnaire (SNOT-22) score had decreased by 22% (p = 0.01) and the nasal polyp score (NPS) had decreased by 48% (p = 0.05). Among patients who had their first follow-up visit ≥6 months from treatment initiation, the SNOT-22 score had decreased by 40% (p = 0.03) and the NPS had decreased by 39% (p = 0.1). The number of patients who needed systemic steroid treatment had decreased by 68% (p < 0.0001), and the number of patients who needed endoscopic sinus surgery had decreased by 74% (p < 0.0001). These findings correspond with the improvement of clinical symptoms observed in prior randomized clinical trials, thus showing the effectiveness of biologic medications in the treatment of severe CRSwNP in a real-life setting. Although further cohort studies are warranted, our study also suggests evaluating patients at follow-up visits mainly by quality-of-life aspects and investigating longer dosing intervals of dupilumab.

show abstract

Quality of life in CRSwNP: evaluation of ACCESS and Lund–Mackay computed tomography scores versus the QoL questionnaire

Cited by 6 publications

References 21 publications

Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics

Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics

The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye

Biological Treatment for Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: Preliminary Real-World Results from a Tertiary Medical Center

Contact Info

Product

Resources

About