Prognostic factors for post-operative outcomes in chronic rhinosinusitis with nasal polyps: a systematic review.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high recurrence rate after surgery despite the availability of medical treatments. Multiple clinical and biological factors have been associated with poor post-operative outcomes in patients with CRSwNP. However, these factors and their prognostic values have not yet been extensively summarized. AREAS COVERED: This systematic review included 49 cohort studies exploring the prognostic factors for post-operative outcomes in CRSwNP. A total of 7802 subjects and 174 factors were included. All investigated factors were classified into three categories according to their predictive value and evidence quality, of which 26 factors were considered plausible for post-operative outcome prediction. Previous nasal surgery, ethmoid-to-maxillary (E/M) ratio, fractional exhaled nitric oxide, tissue eosinophil count or percentage, tissue neutrophil count, tissue IL-5, tissue eosinophil cationic protein, and CLC or IgE in nasal secretion provided more reliable information for prognosis in at least two studies. EXPERT OPINION: Exploring predictors through noninvasive or minimally invasive methods for specimen collection is recommended for future work. Models combining multiple factors must be established, as no single factor is effective for the whole population.

Comparison of Different Biologics for Treating Chronic Rhinosinusitis With Nasal Polyps: A Network Analysis.

BACKGROUND: Several promising clinical trials have demonstrated the effects of type 2 biologics compared with placebos in chronic rhinosinusitis with nasal polyps (CRSwNP). However, there are no head-to-head randomized controlled trials (RCTs) between the biologics. OBJECTIVE: To compare the efficacy and safety of different biologics used for the treatment of CRSwNP. METHODS: We systematically identified RCTs investigating the effects of biologics for CRSwNP. Primary outcomes were nasal polyp score (NPS), nasal congestion severity, and serious adverse events. Secondary outcomes included the 22-item Sino-Nasal Outcome Test (SNOT-22) score, loss of smell severity, the University of Pennsylvania Smell Identification Test score, and the Lund-Mackay computed tomography score. Bucher indirect treatment comparison (ITC) was used to compare the outcome parameters. RESULTS: Seven RCTs (Bachert 2017, OSTRO, POLYP 1, POLYP 2, SINUS-24, SINUS-52, and SYNAPSE) involving 1913 patients and 4 biologics (benralizumab, dupilumab, mepolizumab, and omalizumab) were included for ITC. Dupilumab presented better effects in decreasing NPS and nasal congestion severity compared with the other 3 biologics at 24 weeks of the treatment and at the end of follow-up (more than 48 weeks). Benralizumab was the least effective in reducing nasal congestion severity and SNOT-22 score at 24 weeks. No significant differences were observed between the effects of the other biologics. CONCLUSION: Our current findings suggest that dupilumab exhibits the best efficacy and safety for the treatment of CRSwNP.

[Neuroimmunomodulation in allergic rhinitis].

The role of neuroimmunomodulation in allergic diseases is a research hotspot in recent years. Allergic rhinitis（AR） is caused by overactive immune response to a foreign antigen in nasal mucosa. Immune cells release inflammatory mediators（including histamine, cytokines and neurotrophins）, which directly activate peripheral neurons to mediate nasal congestion, itching, sneezing, and other hyperresponsive symptoms. Upon activation, these peripheral neurons release neurotransmitters （including acetylcholine and norepinephrine） and neuropeptides（including calcitonin gene-related peptide, substance P and vasoactive intestinal peptide） that directly act on immune cells to drive allergic inflammation. Neuro-immune signaling may play a significant role in the pathophysiology of AR. Therefore, a better understanding of these cellular and molecular neuro-immune interactions may inspire the discovery of new targets and novel therapies.