Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines
Por:
Agache, I, Song, Y, Alonso-Coello, P, Vogel, Y, Rocha, C, Sola, I, Santero, M, Akdis, C, Akdis, M, Canonica, GW, Chivato, T, del Giacco, S, Eiwegger, T, Fokkens, W, Georgalas, C, Gevaert, P, Hopkins, C, Klimek, L, Lund, V, Naclerio, R, O'Mahony, L, Palkonen, S, Pfaar, O, Schwarze, J, Soyka, MB, Wang, DY, Zhang, L, Canelo-Aybar, C, Palomares, O, Jutel, M
Publicada:
1 ago 2021
Ahead of Print:
1 mar 2021
Resumen:
This systematic review evaluates the efficacy and safety of biologicals for chronic rhinosinusitis with nasal polyps (CRSwNP) compared with the standard of care. PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CRSwNP-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. RCTs evaluated (dupilumab-2, omalizumab-4, mepolizumab-2, and reslizumab-1) included 1236 adults, with follow-up of 20-64 weeks. Dupilumab reduces the need for surgery (NFS) or oral corticosteroid (OCS) use (RR 0.28; 95% CI 0.20-0.39, moderate certainty) and improves with high certainty smell evaluated with UPSIT score (mean difference (MD) +10.54; 95% CI +9.24 to +11.84) and quality of life (QoL) evaluated with SNOT-22 (MD -19.14; 95% CI -22.80 to -15.47), with fewer treatment-related adverse events (TAEs) (RR 0.95; 95% CI 0.89-1.02, moderate certainty). Omalizumab reduces NFS (RR 0.85; 95% CI 0.78-0.92, high certainty), decreases OCS use (RR 0.38; 95% CI 0.10-1.38, moderate certainty), and improves high certainty smell (MD +3.84; 95% CI +3.64 to +4.04) and QoL (MD -15.65; 95% CI -16.16 to -15.13), with increased TAE (RR 1.73; 95% CI 0.60-5.03, moderate certainty). There is low certainty for mepolizumab reducing NFS (RR 0.78; 95% CI 0.64-0.94) and improving QoL (MD -13.3; 95% CI -23.93 to -2.67) and smell (MD +0.7; 95% CI -0.48 to +1.88), with increased TAEs (RR 1.64; 95% CI 0.41-6.50). The evidence for reslizumab is very uncertain.
Filiaciones:
Agache, I:
Transylvania Univ Brasov, Brasov, Romania
Song, Y:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Alonso-Coello, P:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Vogel, Y:
Furtwangen Univ, Furtwangen, Germany
Rocha, C:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Sola, I:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Santero, M:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Akdis, C:
Univ Zurich, Swiss Inst Allergy & Asthma Res SIAF, Davos, Switzerland
Christine Kuhne Ctr Allergy Res & Educ, Davos, Switzerland
Akdis, M:
Univ Zurich, Swiss Inst Allergy & Asthma Res SIAF, Davos, Switzerland
Canonica, GW:
Humanitas Univ, IRCCS Res Hosp, Personalized Med Asthma & Allergy Clin, Milan, Italy
Chivato, T:
Univ CEU San Pablo, Sch Med, Madrid, Spain
del Giacco, S:
Univ Cagliari, Dept Med Sci & Publ Hlth, Cagliari, Italy
Eiwegger, T:
Hosp Sick Children, Res Inst, Translat Med Program, Toronto, ON, Canada
Univ Toronto, Dept Immunol, Toronto, ON, Canada
Univ Toronto, Hosp Sick Children, Food Allergy & Anaphylaxis Program, Div Immunol & Allergy,Dept Paediat, Toronto, ON, Canada
Univ Toronto, Hosp Sick Children, Food Allergy & Anaphylaxis Program, Div Immunol & Allergy,Dept Immunol, Toronto, ON, Canada
Fokkens, W:
Univ Amsterdam, Acad Med Ctr AMC, Dept Otorhinolaryngol, Amsterdam, Netherlands
Georgalas, C:
Univ Nicosia, Med Sch, Nicosia, Cyprus
Gevaert, P:
Ghent Univ Hosp, Upper Airway Res Lab URL, Dept Otorhinolaryngol, Ghent, Belgium
Hopkins, C:
Guys Hosp, Dept ENT, London, England
Klimek, L:
Zentrum Rhinol & Allergol, Wiesbaden, Germany
Lund, V:
UCLH, Royal Natl Throat Nose & Ear Hosp, London, England
Naclerio, R:
Johns Hopkins Univ, Dept Otolaryngol Head & Neck Surg, Baltimore, MD USA
O'Mahony, L:
Univ Coll Cork, APC Microbiome Ireland, Dept Med, Cork, Ireland
Univ Coll Cork, APC Microbiome Ireland, Dept Microbiol, Cork, Ireland
Palkonen, S:
European Federat Allergy & Airways Dis Patients A, Brussels, Belgium
Pfaar, O:
Philipps Univ Marburg, Univ Hosp Marburg, Sect Rhinol & Allergy, Dept Otorhinolaryngol Head & Neck Surg, Marburg, Germany
Schwarze, J:
Univ Edinburgh, Ctr Inflammat Res Child Life & Hlth, Edinburgh, Midlothian, Scotland
Soyka, MB:
Univ Zurich, Univ Hosp Zurich, Dept Otorhinolaryngol Head & Neck Surg, Zurich, Switzerland
Wang, DY:
Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Otolaryngol, Singapore, Singapore
Zhang, L:
Capital Med Univ, Beijing TongRen Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China
Capital Med Univ, Beijing TongRen Hosp, Dept Allergy, Beijing, Peoples R China
Beijing Inst Otolaryngol, Beijing Key Lab Nasal Dis, Beijing, Peoples R China
Canelo-Aybar, C:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Palomares, O:
Univ Complutense Madrid, Chem Sch, Dept Biochem & Mol Biol, Madrid, Spain
Jutel, M:
Wroclaw Med Univ, Dept Clin Immunol, Wroclaw, Poland
ALL MED Med Res Inst, Wroclaw, Poland
Green Submitted
|