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Top medications identified for chronic sinusitis

Published: September 17, 2021

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the upper airways characterized by progressive polyp growth within the nasal passages. It causes severe congestion, discharge and difficulty with smell which can be devastating with regards to quality of life. Those with concomitant aspirin sensitivity may have life-threatening reactions. The optimal treatment is unclear.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Oykhman et al conducted a systematic review and network meta-analysis of 29 randomized controlled trials involving greater than 3,400 patients evaluating eight advanced therapies (seven biologics and aspirin desensitization) for CRSwNP. The study is the first of its kind to systematically compare the effectiveness and safety of multiple sinusitis treatments.

The findings showed that dupilumab consistently and uniquely ranked among the most beneficial treatment for seven out of seven positive patient outcomes including sinusitis symptoms, sense of smell, quality of life, need for rescue surgery, need for rescue systemic steroids such as prednisone, nasal polyp size, and severity on imaging. Other treatments, such as omalizumab, mepolizumab, benralizumab and aspirin therapy all greatly improved one or two key outcomes.

The authors conclude that this study provides clear evidence regarding the best sinusitis treatments. Patients, clinicians, and policy makers can now be fully informed on how to select from the full menu of treatment options. As such, this study should influence practice guidelines globally, balancing the key clinical differences seen in effects of the treatments against other considerations like treatment cost and patient values and preferences.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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