Comparison of the clinical outcomes of patients with NSAID-exacerbated respiratory disease receiving aspirin or biologicals

Abstract

Objective

NSAID-exacerbated respiratory disease (NERD) is characterized by exacerbation of respiratory symptoms after NSAID intake. While research for specific treatment options continues in patients who cannot tolerate or are unresponsive to aspirin treatment after aspirin desensitization (ATAD), biologicals have emerged as a new therapeutic option in NERD patients. The aim of this study was to compare the quality of life, and the sinonasal and respiratory outcomes of NERD patients treated with ATAD or biologicals.

Methods

Patients who have been followed up at a tertiary care allergy center and who have been receiving at least one of ATAD, mepolizumab or omalizumab for at least six months were included. Evaluations were made using sinonasal outcome test (SNOT-22), asthma control test (ACT), short form-36 (SF-36), blood eosinophil counts, need for recurrent functional endoscopic sinus surgeries (FESS), and asthma or rhinitis exacerbations requiring oral corticosteroids (OCS).

Results

A total of 59 patients comprised of 35 (59%) females and 24 (41%) males with a mean age of 46.1 (min-max, 20–70) years were included. The baseline blood eosinophil count was higher, and a significant decrease in blood eosinophil counts was observed in the mepolizumab group compared to ATAD group (p = 0.001, p < 0.001, respectively). At follow-up, the rate of recurrent FESS was lower in the group that received mepolizumab (p = 0.02).

Conclusions

In NERD patients, mepolizumab significantly decreased blood eosinophil counts and recurrent FESS. There was no significant difference between the patients receiving ATAD or mepolizumab regarding other clinical parameters.

Keywords:

• NERD
• NSAID intolerance
• nasal polyp
• aspirin desensitization
• severe asthma
• omalizumab
• mepolizumab

Acknowledgments

I would like to thank Esra Demirtas and Ferdane Karaman for their technical support during injection applications and oral aspirin provocation tests at our clinic.

In addition, I commemorate with respect, love, and longing all my friends and relatives who were affected by the earthquakes in Kahramanmaras on February 6, 2023, who lost their lives in Kahramanmaras and Hatay, especially in Adıyaman, my hometown, and who have an important place in my education life. I will be grateful to you as long as I live for all the beauty and human values you have added to my life.

Declaration of interest

The authors declare that there is no conflict of interest.

Authors’ contributions

A.F.K. conceived of presented idea, G.T, E.D O.C.B, M.C, H.K contributed to sample preparation. G.T took the lead in writing the manuscript, S. O, A.F.K, E.D, and G.K contributed to the design and implementation of the research, to the analysis of the results, and critically reviewed the manuscript.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.