Biologic therapies versus surgical management for aspirin-exacerbated respiratory disease: A review of preliminary data, efficacy, and cost
Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surge...
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| Published in | World Journal of Otorhinolaryngology-Head and Neck Surgery Vol. 6; no. 4; pp. 230 - 234 |
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| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
China
Elsevier B.V
01.12.2020
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA KeAi Publishing Wiley |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies. |
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| AbstractList | Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies. Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies.Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies. Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies. Aspirin-Exacerbated Respiratory Disease (AERD) is a type 2 (Th2)-mediated inflammatory disease characterized by chronic rhinosinusitis (CRS), nasal polyposis, rhinorrhea and asthma exacerbated by nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (aspirin/ASA). 1 From a rhinologic standpoint, AERD patients are recognized as a subset of patients CRS with nasal polyps (CRSwNP), with AERD affecting approximately 1% of the United States population. 2 Broadly, CRSwNP patients demonstrate derangements of several Th2 pathways, including dysregulation of the interleukin (IL)-4, IL-5, and IL-13. Cytokine levels are altered systemically, in the nasal mucosa, and in polyp tissue itself, while mast cells and eosinophils are also increased locally. 3, 4, 5, 6 From a rhinologic standpoint, patients with AERD are often considered to be among the most difficult to treat CRS patients, due to severity and disease recalcitrance.6 This is reflected at the cellular and molecular level; nasal polyps from patients with AERD have over 3 times as many eosinophils and higher IL-5 concentrations when compared to polyps taken from subjects with non-AERD CRS. 7, 8 |
| Abstract_FL | Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies. Aspirin-Exacerbated Respiratory Disease (AERD) is a type 2 (Th2)-mediated inflammatory disease characterized by chronic rhinosinusitis (CRS), nasal polyposis, rhinorrhea and asthma exacerbated by nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (aspirin/ASA).
1 From a rhinologic standpoint, AERD patients are recognized as a subset of patients CRS with nasal polyps (CRSwNP), with AERD affecting approximately 1% of the United States population.
2 Broadly, CRSwNP patients demonstrate derangements of several Th2 pathways, including dysregulation of the interleukin (IL)-4, IL-5, and IL-13. Cytokine levels are altered systemically, in the nasal mucosa, and in polyp tissue itself, while mast cells and eosinophils are also increased locally.
3,
4,
5,
6 From a rhinologic standpoint, patients with AERD are often considered to be among the most difficult to treat CRS patients, due to severity and disease recalcitrance.6 This is reflected at the cellular and molecular level; nasal polyps from patients with AERD have over 3 times as many eosinophils and higher IL-5 concentrations when compared to polyps taken from subjects with non-AERD CRS.
7,
8 |
| Author | Workman, Alan D. Bleier, Benjamin S. |
| AuthorAffiliation | Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA |
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| Author_FL | Bleier Benjamin S Workman Alan D |
| Author_FL_xml | – sequence: 1 fullname: Workman Alan D – sequence: 2 fullname: Bleier Benjamin S |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33336178$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1177_19458924211033214 crossref_primary_10_1186_s40463_023_00682_1 crossref_primary_10_1016_j_jaci_2021_09_009 crossref_primary_10_3390_jpm12050846 crossref_primary_10_1177_19458924211001640 crossref_primary_10_1016_j_jaip_2022_06_016 crossref_primary_10_1016_j_wjorl_2020_05_011 crossref_primary_10_1016_j_jaip_2024_09_021 crossref_primary_10_1016_j_anai_2023_05_016 crossref_primary_10_1186_s40463_023_00626_9 crossref_primary_10_1002_alr_22977 crossref_primary_10_1016_j_jaip_2022_03_021 |
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| Copyright | 2020 The Authors 2020 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons, Ltd on behalf of Chinese Medical Association 2020 The Authors. Copyright © Wanfang Data Co. Ltd. All Rights Reserved. 2020 The Authors 2020 |
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| Title | Biologic therapies versus surgical management for aspirin-exacerbated respiratory disease: A review of preliminary data, efficacy, and cost |
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