Predictors of Sinonasal Improvement After Highly Effective Modulator Therapy in Adults with Cystic Fibrosis-Reference-Cited by-同舟云学术

Predictors of Sinonasal Improvement After Highly Effective Modulator Therapy in Adults with Cystic Fibrosis

Published:2024-04-18 Issue:9 Volume:134 Page:3965-3973
ISSN:0023-852X
Container-title:The Laryngoscope
language:en
Short-container-title:The Laryngoscope

Author:

Beswick Daniel M.¹^ORCID,Liu Christine M.¹^ORCID,Overdevest Jonathan B.²^ORCID,Zemke Anna³,Khatiwada Aastha⁴,Gudis David A.²^ORCID,Miller Jessa E.¹^ORCID,Kimple Adam⁵,Tervo Jeremy P.²,DiMango Emily⁶,Goralski Jennifer L.⁷,Keating Claire⁶,Senior Brent⁵,Stapleton Amanda L.⁸,Eshaghian Patricia H.⁹,Mace Jess C.¹⁰,Markarian Karolin¹¹,Alt Jeremiah A.¹²^ORCID,Bodner Todd E.¹³,Chowdhury Naweed I.¹⁴,Getz Anne E.¹⁵,Hwang Peter H.¹⁶,Khanwalker Ashoke¹⁵,Lee Jivianne T.¹^ORCID,Li Douglas A.⁹,Norris Meghan⁵,Nayak Jayakar V.¹⁶^ORCID,Owens Cameran¹⁵,Patel Zara M.¹⁶^ORCID,Poch Katie¹⁷,Schlosser Rodney J.¹⁸,Smith Kristine A.¹²,Smith Timothy L.¹⁰^ORCID,Soler Zachary M.¹²^ORCID,Suh Jeffrey D.¹,Turner Grant A.¹⁰,Wang Marilene B.¹,Saavedra Milene T.¹⁷,Taylor Cousar Jennifer L.¹⁷¹⁹

Affiliation:

1. Department of Otolaryngology‐Head and Neck Surgery University of California Los Angeles California U.S.A.

2. Department of Otolaryngology‐Head and Neck Surgery Columbia University New York New York U.S.A.

3. Division of Pulmonary Medicine University of Pittsburgh Pittsburgh Pennsylvania U.S.A.

4. Department of Biostatistics National Jewish Health Denver Colorado U.S.A.

5. Department of Otolaryngology‐Head and Neck Surgery University of North Carolina Chapel Hill North Carolina U.S.A.

6. Division of Pulmonary, Allergy and Critical Care Medicine Columbia University New York New York U.S.A.

7. Department of Pulmonary Medicine University of North Carolina Chapel Hill North Carolina U.S.A.

8. Department of Otolaryngology‐Head and Neck Surgery University of Pittsburgh Pittsburgh Pennsylvania U.S.A.

9. Department of Pulmonary Medicine University of California Los Angeles California U.S.A.

10. Department of Otolaryngology‐Head and Neck Surgery Oregon Health & Science University Portland Oregon U.S.A.

11. CTSI, David Geffen School of Medicine University of California Los Angeles California U.S.A.

12. Department of Otolaryngology‐Head and Neck Surgery University of Utah Salt Lake City Utah U.S.A.

13. Department of Psychology Portland State University Portland Oregon U.S.A.

14. Department of Otolaryngology‐Head and Neck Surgery Vanderbilt Health Nashville Tennessee U.S.A.

15. Department of Otolaryngology‐Head and Neck Surgery University of Colorado Aurora Colorado U.S.A.

16. Department of Otolaryngology‐Head and Neck Surgery Stanford University Stanford California U.S.A.

17. Department of Medicine National Jewish Health Denver Colorado U.S.A.

18. Department of Otolaryngology‐Head and Neck Surgery Medical University of South Carolina Greenville South Carolina U.S.A.

19. Department of Pediatrics National Jewish Health Denver Colorado U.S.A.

Abstract

ObjectivesThe 22‐question SinoNasal Outcome Test (SNOT‐22) assesses chronic rhinosinusitis (CRS) severity. We aimed to identify predictors of SNOT‐22 score improvement following highly effective modulator therapy (HEMT) initiation and to corroborate the SNOT‐22 minimal clinically important difference (MCID) in adults with cystic fibrosis (CF).MethodsProspective observational data was pooled from four studies across 10 US centers investigating people with CF (PwCF) and CRS. Three studies evaluated HEMT's impact on CRS. For participants enrolled prior to HEMT initiation, SNOT‐22 scores were obtained at baseline and after 3–6 months of HEMT. Multivariate regression identified predictors of improvement. Cronbach's alpha and four distribution‐based methods were used to assess internal consistency and calculate the MCID of the SNOT‐22.ResultsA total of 184 PwCF participated with mean baseline SNOT‐22 scores ranging from 18.1 to 56.7. Cronbach's alpha was ≥0.90 across sites. Participants at sites with pre‐ and post‐HEMT data reported improvement in SNOT‐22 scores after initiating HEMT (all p < 0.05). Worse baseline SNOT‐22 score (odds ratio (OR): 1.05, p < 0.001, 95% CI: 1.02–1.08), F508del homozygosity (OR: 4.30, p = 0.040, 95% CI: 1.14–18.99), and absence of prior modulator therapy (OR: 4.99, p = 0.017, 95% CI: 1.39–20.11) were associated with greater SNOT‐22 improvement. The mean MCID calculated via distribution‐based methods was 8.5.ConclusionWorse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater improvement after HEMT initiation. The mean MCID for SNOT‐22 in PwCF is 8.5 points, similar to non‐CF individuals with CRS, and provides a threshold specifically for PwCF. The SNOT‐22 has strong internal consistency in PwCF.Level of Evidence3 Laryngoscope, 134:3965–3973, 2024

Funder

Cystic Fibrosis Foundation

National Institute on Deafness and Other Communication Disorders

Publisher

Wiley

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1002/lary.31438

Reference37 articles.

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