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Perioperative mepolizumab in aspirin-exacerbated respiratory disease does not prevent nasal polyp regrowth

2023; Elsevier BV; Volume: 131; Issue: 3 Linguagem: Inglês

10.1016/j.anai.2023.06.017

1534-4436

Andrew D. Supron, Regan W. Bergmark, Rachel E. Roditi, Kathleen M. Buchheit,

Respiratory and Cough-Related Research

Aspirin-exacerbated respiratory disease (AERD) is defined by the triad of asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and respiratory reactions to medications that inhibit cyclooxygenase-1. Of these elements, patients with AERD cite CRSwNP symptoms as the most impactful on quality of life. 1 Ta V White AA. Survey-defined patient experiences with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol Pract. 2015; 3: 711-718 Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar Patients with AERD are less likely to respond to first-line therapy with intranasal glucocorticoids and more likely to require multiple functional endoscopic sinus surgeries (FESS) compared with those with aspirin-tolerant CRSwNP. 2 McMains KC Kountakis SE. Medical and surgical considerations in patients with Samter's triad. Am J Rhinol. 2006; 20: 573-576 Crossref PubMed Scopus (70) Google Scholar Histologically, nasal tissue eosinophil levels are higher in patients with AERD compared to aspirin-tolerant patients with CRSwNP. 3 Stevens WW Ocampo CJ Berdnikovs S Sakashita M Mahdavinia M Suh L et al. Cytokines in chronic rhinosinusitis. Role in eosinophilia and aspirin-exacerbated respiratory disease. Am J Respir Crit Care Med. 2015; 192: 682-694 Crossref PubMed Scopus (208) Google Scholar These findings together emphasize the need for effective CRSwNP treatments and suggest a possible role for eosinophil-targeting agents in AERD. However, near-total depletion of nasal polyp tissue eosinophils with dexpramipexole failed to improve symptoms and reduce polyp burden among patients with CRSwNP, which suggests that eosinophils alone may not be the primary drivers of tissue inflammation in patients with CRSwNP. 4 Laidlaw TM Prussin C Panettieri RA Lee S Ferguson BJ Adappa ND et al. Dexpramipexole depletes blood and tissue eosinophils in nasal polyps with no change in polyp size. Laryngoscope. 2019; 129: E61-E66 Crossref PubMed Scopus (70) Google Scholar ,5 Buchheit KM Lewis E Gakpo D Hacker J Sohail A Taliaferro F et al. Mepolizumab targets multiple immune cells in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2021; 148: 574-584 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar