Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review

Shah, Gopi; Keyzer, L. De; Russell, Joy; Halderman, Ashleigh A.

doi:10.1002/alr.22082

Cited by 20 publications

(10 citation statements)

References 26 publications

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“…There is a surprising dearth of studies investigating the efficacy of mucolytics for the treatment of CRS. Most of the recent literature describes their use in the treatment of CRS in patients with CF in which topical Dornase‐alfa led to some improvement in nasal symptom scores 1210,1211 …”

Section: Chronic Rhinosinusitis Without Nasal Polyps (Crssnp)mentioning

confidence: 99%

“…Mucolytic agents such as Dornase alfa reduce the viscosity of sinonasal mucus by cleaving extracellular DNA known to accumulate in CF upper and lower airways due to extensive neutrophil degradation 2383 . A 2018 systematic review showed consistent improvement of sinonasal symptom scores with topical dornase alfa compared to topical saline alone 1211 . However, the drug's impact on pulmonary function and endoscopic scores was variable, leading the authors to suggest the need for larger studies.…”

Section: Special Considerations In Rhinosinusitismentioning

confidence: 99%

See 1 more Smart Citation

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

525

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Section: Chronic Rhinosinusitis Without Nasal Polyps (Crssnp)mentioning

confidence: 99%

Section: Special Considerations In Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

525

479

View full text Add to dashboard Cite

show abstract

“…Furthermore, Cimmino et al revealed that children with CF receiving DNAse via sidestream nebulizer presented a significant improvement in sinonasal symptoms and Lund-Mackay scores [44]. Finally, a systematic review in 2018 on chronic rhinosinusitis in CF patients, confirmed these results [45].…”

Section: Effect Of Dnase On Sinonasal Problems In Cystic Fibrosis Pat...mentioning

confidence: 92%

Dornase alfa in Cystic Fibrosis: indications, comparative studies and effects on lung clearance index

et al. 2022

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Cystic fibrosis (CF) is the most common inherited disease in Caucasian populations, affecting around 50,000 patients in Europe and 30,000 in United States. A mutation in CF trans-membrane conductance regulator (CFTR) gene changes a protein (a regulated chloride channel), which is expressed in many tissues. Defective CFTR results in reduced chloride secretion and an overage absorption of sodium across the epithelia, leading to thickened secretions in organs such as pancreas and lung. Gradually, there have been considerable improvements in the survival of people with CF, thanks to substantial changes in specialized CF care and the discovery of new CFTR modulators drugs. Nevertheless, lung disease remains the most common cause of death. For these reasons improvement of sputum clearance is a major therapeutic aim in CF. So far, symptomatic mucolytic therapy is mainly based on inhalation of dornase alfa, hypertonic saline or mannitol, in combination with physiotherapy. The major component of mucus in CF is pus including viscous material such as polymerized DNA derived from degraded neutrophils. Dornase alfa cleaves the DNA released from the neutrophils and reduces mucous viscosity, and further prevent airway infections and damage to the lung parenchyma. In this review we will summarize the current knowledge on dornase alfa in the treatment of CF lung disease, especially highlighting the positive effect on lung clearance index, a sensitive measure of ventilation inhomogeneity.

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“…Although small randomized-controlled trials and systematic reviews have reported improved quality of life (QOL) and decreases in SNOT-22 scores in patients with CF and CRS with the use of topical nasal dornase alfa, steroids, antimicrobials, isotonic and hypertonic saline, there is no available data on these therapies in CFLTRs. 58,[60][61][62][63][64] One small study examined the impact of a CFTR modulator, ivacaftor, on CRS and reported a clinically insignificant decrease in SNOT-22 scores and improved QOL. 65 Since appropriate sinus treatment could potentially decrease allograft infection in CFLTRs, consultation with an otolaryngologist with CF expertise is recommended to individualize therapy for CFLTRs with symptomatic CRS.…”

Section: Sinus Diseasementioning

confidence: 99%

Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients

Shah¹,

Lowery²,

Chaparro³

et al. 2021

The Journal of Heart and Lung Transplantation

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Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review

Abstract: Topical intranasal dornase appears to improve sinonasal symptoms in CF patients to a greater degree than saline alone. The impact on other outcomes is less clear. Larger studies are needed to fully elucidate the true efficacy of dornase alfa in the treatment of CRS in CF patients.

Cited by 20 publications

References 26 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Dornase alfa in Cystic Fibrosis: indications, comparative studies and effects on lung clearance index

Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients

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