Histopathologic features of biologic therapy nonresponders in chronic rhinosinusitis with nasal polyposis

被引:5
作者
Baird, Ali M. [1 ]
Masliah, Jamie [2 ]
Filip, Peter [2 ]
Talati, Vidit [2 ]
Brown, Hannah J. [1 ]
Owen, Grant [1 ]
Khalife, Sarah [2 ]
Papagiannopoulos, Peter [2 ]
Gattuso, Paolo [3 ]
Batra, Pete S. [2 ]
Tajudeen, Bobby A. [2 ,4 ]
机构
[1] Rush Univ, Med Ctr, Rush Med Coll, Chicago, IL USA
[2] Rush Univ, Med Ctr, Dept Otorhinolaryngol Head & Neck Surg, Chicago, IL USA
[3] Rush Univ, Med Ctr, Dept Pathol, Chicago, IL USA
[4] Rush Univ, Med Ctr, Dept Otorhinolaryngol Head & Neck Surg, Div Rhinol Sinus Surg & Skull Base Surg, 1611 W Harrison St, Suite 550, Chicago, IL 60612 USA
关键词
biologic therapy; chronic rhinosinusitis; endotypes; nasal polyps; structured histopathology; EOSINOPHILIA;
D O I
10.1002/alr.23283
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
BackgroundBiologics are effective for chronic rhinosinusitis with nasal polyposis (CRSwNP) by reducing type 2 inflammation. Nonresponders often require functional endoscopic sinus surgery (FESS) and represent a challenging population potentially due to non-type 2 pathophysiology. This study characterizes the histopathologic features of biologic nonresponders.MethodsA retrospective review of 257 CRSwNP patients undergoing FESS was conducted. The biologic nonresponder group included patients with prior biologic therapy who exhibited persistent symptoms and polyp burden. Those with CRSwNP not prescribed biologic therapy were selected as controls. Demographics, comorbidities, and structured histopathology consisting of 13 variables were collected.ResultsOf 257 CRSwNP patients, 20 were on biologics prior to FESS. Fourteen patients (70.0%) received dupilumab, one (5.0%) received mepolizumab, one (5.0%) received omalizumab, and four (20.0%) tried multiple biologics. The mean age for the biologic nonresponder group was 45.8 years compared to 50.4 years for the controls. Nonresponders had a significantly increased incidence of reduced tissue eosinophilia, defined as <5 per high power field (55% vs. 31.2%, p = 0.044) and increased basement membrane thickening (100% vs. 78.1%, p = 0.017). The remaining 11 variables did not reach statistical significance.ConclusionHistopathologic analysis of biologic nonresponders demonstrates decreased eosinophilia and thickened basement membranes. These findings, particularly low tissue eosinophils, are consistent with a non-type 2 CRSwNP that may be recalcitrant to biologic therapies. Histopathologic analysis done in conjunction with FESS may aid clinicians in understanding response to biologic therapies in patients with CRSwNP who have persistent symptom burden necessitating FESS.
引用
收藏
页码:939 / 949
页数:11
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