Mihai A. Bentan BA, Graham Pingree BA, Lawrance Lee MD, Thomas Fitzpatrick MD, Theodore Schuman MD
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The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%–13.15%, <i>p</i> < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%–19.68%, <i>p</i> = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%–15.40%, <i>p</i> < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%–10.15%, <i>p</i> < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%–7.61%, <i>p</i> < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%–4.12%, <i>p</i> = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%–11.09%, <i>p</i> = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%–22.57%, <i>p</i> < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%–19.14%, <i>p</i> < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%–12.17%, <i>p</i> = 0.005).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>NA <i>Laryngoscope</i>, 135:593–601, 2025</p>\n </section>\n </div>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":"135 2","pages":"593-601"},"PeriodicalIF":2.2000,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lary.31774","citationCount":"0","resultStr":"{\"title\":\"Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis\",\"authors\":\"Mihai A. 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引用次数: 0
摘要
目的比较th2靶向生物药物（dupilumab、omalizumab和mepolizumab）在降低慢性鼻息肉性鼻炎（CRSwNP）和过敏性真菌性鼻炎（AFRS）患者接受功能性内窥镜鼻窦手术（FESS）的绝对风险（ARR）方面的疗效。方法在TriNetX研究网络数据库中查询每种mAb在2024年3月之前的市场寿命。根据年龄、性别、种族和哮喘诊断结果，将患有 CRSwNP 的成人与非 mAb 对照组进行倾向评分匹配。主要结果是FESS率，次要结果包括住院率、急诊科就诊率和急性鼻窦炎发病率。结果所有 mAbs 都降低了 CRSwNP 患者的 FESS 风险（dupilumab，ARR 11.48%，95% CI 9.82%-13.15%，p = 0.001；omalizumab，ARR 12.02%，95% CI 4.36%-19.68%，p = 0.002；mepolizumab，ARR 10.32%，95% CI 5.24%-15.40%，p = 0.001）。只有杜比单抗还降低了住院风险（ARR 8.59%，95% CI 7.04%-10.15%，p <0.001）、急诊室就诊风险（ARR 5.94%，95% CI 4.28%-7.61%，p <0.001）和急性鼻窦炎风险（ARR 2.60%，95% CI 1.09%-4.12%，p = 0.001）。在 AFRS 患者中，只有 dupilumab 能降低所有结果的风险：FESS（ARR 6.97%，95 CI 2.86%-11.09%，P = 0.001）、住院（ARR 16.93%，95 CI 11.30%-22.57%，P <0.001）、ED 就诊（ARR 13.15%，95 CI 7.15%-19.14%，P <0.结论虽然所有 mAbs 都能降低 CRSwNP 的 FESS 风险，但只有 dupilumab 还能降低次要结局。同样，只有 dupilumab 能改善 AFRS 患者的所有预后。这些数据证明了 mAbs 在减轻 CRSwNP 和 AFRS 患者的疾病负担和改善患者预后方面的潜力。
Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis
Objective
To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).
Methods
The TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.
Results
All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%–13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%–19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%–15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%–10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%–7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%–4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%–11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%–22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%–19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%–12.17%, p = 0.005).
Conclusion
Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
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