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Eosinophilic asthma patients with chronic rhinosinusitis with nasal polyps appear highly responsive to reslizumab

Published online: September 4, 2018

Asthma is often associated with chronic rhinosinusitis (CRS), an inflammatory disease of the paranasal sinuses, and nasal polyps (NP), which are swellings of the normal nasal lining due to inflammation. Patients with asthma and CRS with NP (CRSwNP) tend to have severe asthma symptoms and low quality of life. Furthermore, aspirin sensitivity along with CRSwNP can lead to further aggravation of symptoms. Depending on the extent of eosinophilic inflammation, CRSwNP can be accompanied by an increase in Th2 cytokine levels, such as interleukin IL-5, which in turn is associated with recurrence of NP and need for sinus surgery. As such, inhibition of IL-5 has been identified as a promising therapeutic approach for the treatment of eosinophilic CRSwNP.

Reslizumab is a monoclonal antibody targeting IL-5, which has been shown in three Phase 3 placebo-controlled trials to significantly improve several measures of asthma control in patients with eosinophilic asthma. In a recent study published in The Journal of Allergy & Clinical Immunology: In Practice, Weinstein and colleagues performed a post-hoc analysis of data from two of these Phase 3 trials. They hypothesized that, despite the often difficult-to-treat nature of asthma associated with CRSwNP, asthma-related outcomes in subgroups of patients with eosinophilic asthma and CRSwNP (with or without aspirin sensitivity) would be similar to those in the overall population of patients with eosinophilic asthma after 52 weeks of weight-based treatment with reslizumab (intravenously, every 4 weeks).

The authors found that, compared to the population of patients with asthma but without CRSwNP, patients with CRSwNP had a nominally larger reduction in frequency of asthma attacks (83% vs 44%), regardless of aspirin sensitivity. Lung function was also clinically and statistically significantly improved in patients with CRSwNP with and without aspirin sensitivity. Finally, treatment with reslizumab resulted in clinically and statistically significant improvements in patient-reported asthma control and quality of life among patients with CRSwNP. This study suggests that patients with eosinophilic asthma and CRSwNP are highly responsive to treatment with reslizumab for asthma-related outcomes. Prospective, controlled trials are needed to confirm these promising findings.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Effects of reslizumab on asthma outcomes in a subgroup of eosinophilic asthma patients with self-reported chronic rhinosinusitis with nasal polyps
Steven F. Weinstein, MD, Rohit K. Katial, MD, Philip Bardin, MD, Stephanie Korn, Dr Med, Mirna McDonald, MS (Biostatistics), Margaret Garin, MD, MSCR, Eric D. Bateman, FRCP, Flavia C.L. Hoyte, MD, Matthew Germinaro, MD