Cochrane review: biologic therapy offers benefit in severe chronic rhinosinusitis

  • Chong LY & al.
  • Cochrane Database Syst Rev
  • 27 Feb 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • The anti-IL4Rα monoclonal antibody dupilumab improves health-related QoL (HRQL), symptom severity, and need for surgery in severe chronic rhinosinusitis with nasal polyps, according to this Cochrane meta-analysis.

Why this matters

  • First meta-analysis to analyze effects of biologics for the treatment of chronic rhinosinusitis, which affects about 11% of the UK population.

Study design

  • Meta-analysis of 8 randomized controlled trials (RCTs; N=986) with at least 3 months' follow-up.
  • Primary outcome was HRQL, disease severity, and serious adverse events (AEs).
  • HRQL was measured by SinoNasal Outcome Test-22 (SNOT-22; scores 0-110 points, with lower scores indicating better outcome. Minimal clinically important difference was 8.9 points).
  • Funding: All RCTs were industry sponsored.

Key results

  • Most participants (n=784) were in 3 RCTs of dupilumab.
  • At 24 weeks, the dupilumab patients had SNOT-22 scores 19.61 points lower (better) than control individuals:
    • Mean difference (MD): −19.61 (95% CI, −22.54 to −16.69).
  • Dupilumab patients had better symptom severity using a 0-10 point visual analogue scale:
    • MD: −3.00 (95% CI, −3.47 to −2.53).
  • Dupilumab patients had lower risk for serious adverse events:
    • Risk ratio, 0.45 (95% CI, 0.28-0.75).
  • Dupilumab patients had fewer actual or planned nasal polyp surgeries:
    • Risk ratio: 0.17 (95% CI, 0.05-0.52).
  • Results less certain with mepolizumab, omalizumab.

Limitations

  • Small number of studies, participants.