Real-Life Experience of Biologic Treatment for Asthma on Chronic Rhinosinusitis: A Finnish Cohort

Abstract

<b><i>Introduction:</i></b> Biologics are used in the treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The purpose of this retrospective study was to evaluate the effects of biologics initiated for asthma on coexistent CRS and the influence of comorbid factors, including aspirin-exacerbated respiratory disease (AERD) and secretory otitis media (SOM). <b><i>Methods:</i></b> A review of electronic health records (2009–2020) at a Finnish tertiary center was conducted to identify CRS patients treated with biologics for their asthma. We identified the type of biologic and treatment response, by comparing nasal polyp score (NPS), sinonasal outcome test (SNOT)-22, need for oral corticosteroids (OCS) and antibiotics, frequency of visits, and endoscopic sinus surgeries (ESS) pretreatment and during treatment. <b><i>Results:</i></b> 55 patients were treated with anti-immunoglobulin E (IgE) (<i>n</i> = 18) or anti-interleukin-5/5-receptor (IL-5/5R) (<i>n</i> = 37) biologics. Treatment lasted for an average of 4.1 years. Seventy-five percent (<i>n</i> = 41) had CRSwNP and 25% (<i>n</i> = 14) had CRSsNP. Of all patients, 24% (<i>n</i> = 13) had comorbid AERD and 22% (<i>n</i> = 12) had SOM. Biologic therapy reduced the need for OCS courses (anti-IgE, <i>n</i> = 17, <i>p</i> = 0.03; anti-IL-5/5R, <i>n</i> = 35, <i>p</i> = 0.01) and for daily OCS in anti-IL-5/5R (<i>n</i> = 35, <i>p</i> = 0.001) but not in anti-IgE patients (<i>n</i> = 16, <i>p</i> = 0.07). Biologics also improved NPS by 0.5 point (<i>n</i> = 32, <i>p</i> = 0.009) and SNOT-22 by 14 points (<i>n</i> = 7, <i>p</i> = 0.02) in CRSwNP patients. The overall discontinuation rate was 37.7% (<i>n</i> = 20) and was independent of type of biologic. <b><i>Conclusion:</i></b> Treatment with anti-IgE and/or anti-IL-5/5R biologics reduced the overall need for OCS medication in individuals with asthma and concomitant CRS, but despite this, the discontinuation rate was high.