Mepolizumab for chronic rhinosinusitis with nasal polyps: treatment efficacy by comorbidity and blood eosinophil count

Background: Eosinophilic nasal polyps (NPs) are associated with the presence of asthma in chronic rhinosinusitis (CRS) patients. Serum periostin has been considered a relevant biomarker for unified airway diseases. Objective: To determine the utility of biomarkers including serum periostin that reflects reduction of exacerbations of comorbid asthma in CRS patients. Methods: We prospectively recruited 56 CRS patients who were subjected to undergo endoscopic sinus surgery (ESS) (20 with asthma) between October 2015 and December 2017 and followed them for 1 year after ESS. Blood eosinophil count, serum periostin, and fractional nitric oxide (FeNO) were measured at enrollment. How these type 2-driven biomarkers reflect comorbid asthma was determined using receiver operating characteristic (ROC) analysis. The frequency of asthma exacerbations during 1 year was counted both before and after ESS. Associations between preoperative biomarkers including eosinophils in NPs and asthma exacerbations were evaluated. Results: Blood eosinophil count, FeNO, and serum periostin levels were significantly higher in CRS patients with asthma than in those without (p < 0.01 for all) and discriminated comorbid asthma among CRS patients (p < 0.05; AUC > 0.80 for all). The increased preoperative serum periostin correlated with lower absolute number of postoperative exacerbations (ρ = −0.49, p = 0.03) and its relative reduction after ESS (ρ = 0.53, p = 0.03) in asthmatic patients. Increased eosinophils in NPs were also associated with reduced asthma exacerbations. Conclusion: Preoperative increased serum periostin and eosinophils in NPs are associated with the preventive effect of ESS for asthma exacerbations in CRS patients comorbid with asthma.

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Diagnostic significance of blood eosinophil count in eosinophilic chronic rhinosinusitis with nasal polyps in Chinese adults

The Laryngoscope ◽

10.1002/lary.22507 ◽

2012 ◽

Vol 122 (3) ◽

pp. 498-503 ◽

Cited By ~ 64

Author(s):

Ying Hu ◽

Ping-Ping Cao ◽

Geng-Tian Liang ◽

Yong-Hua Cui ◽

Zheng Liu

Keyword(s):

Chronic Rhinosinusitis ◽

Eosinophil Count ◽

Nasal Polyps ◽

Blood Eosinophil ◽

Chinese Adults ◽

Diagnostic Significance ◽

Blood Eosinophil Count ◽

Eosinophilic Chronic Rhinosinusitis

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Real-life effects of benralizumab on allergic chronic rhinosinusitis and nasal polyposis associated with severe asthma

International Journal of Immunopathology and Pharmacology ◽

10.1177/2058738420950851 ◽

2020 ◽

Vol 34 ◽

pp. 205873842095085 ◽

Cited By ~ 3

Author(s):

Nicola Lombardo ◽

Corrado Pelaia ◽

Marco Ciriolo ◽

Marcello Della Corte ◽

Giovanna Piazzetta ◽

...

Keyword(s):

Allergic Asthma ◽

Chronic Rhinosinusitis ◽

Severe Asthma ◽

Eosinophil Count ◽

Nasal Polyposis ◽

Rating Scale ◽

Real Life ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Snot 22

The aim of this study has been to evaluate the efficacy of the IL-5 receptor blocker benralizumab on chronic rhinosinusitis with nasal polyposis (CRSwNP), associated with severe eosinophilic allergic asthma. Ten patients with severe eosinophilic allergic asthma and CRSwNP were enrolled. Sino-nasal outcome test (SNOT-22), numerical rating scale (NRS), endoscopic nasal polyp score, Lund Mackey CT (computed tomography) score, and blood eosinophil count were measured at baseline and after 24 weeks of treatment with benralizumab. All the above clinical, endoscopic, imaging, and hematological parameters significantly improved after 24 weeks of treatment with benralizumab. In particular, SNOT-22 decreased from 61.10 ± 17.20 to 26.30 ± 19.74 ( P < 0.001), NRS decreased from 7.20 ± 1.55 to 3.40 ± 2.22 ( P < 0.001), the endoscopic polyp nasal score decreased from 4.20 ± 1.32 to 2.50 ± 1.78 ( P < 0.001), the Lund-Mackay CT score decreased from 16.60 ± 5.50 to 6.90 ± 5.99 ( P < 0.001), and blood eosinophil count decreased from 807.3 ± 271.1 cells/μL to 0 cells/μL ( P < 0.0001). These results strongly suggest that benralizumab exerted a very effective therapeutic action on CRSwNP associated with severe asthma, thus improving nasal symptoms and decreasing polyp size.

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Significance of Blood Eosinophil Count in Patients with Chronic Rhinosinusitis with Nasal Polyposis

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2017/25320.9445 ◽

2017 ◽

Cited By ~ 1

Author(s):

Ammu Sreeparvathi

Keyword(s):

Chronic Rhinosinusitis ◽

Eosinophil Count ◽

Nasal Polyposis ◽

Blood Eosinophil ◽

Blood Eosinophil Count

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Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

Allergy & Rhinology ◽

10.1177/2152656720956596 ◽

2020 ◽

Vol 11 ◽

pp. 215265672095659

Author(s):

P. Virkkula ◽

E. Penttilä ◽

S. I. Vento ◽

J. Myller ◽

A. Koskinen ◽

...

Keyword(s):

Surgical Treatment ◽

Eosinophil Count ◽

Nasal Polyps ◽

Characteristic Curve ◽

Threshold Value ◽

Blood Eosinophil ◽

Cross Sectional ◽

Available N ◽

Peripheral Blood Eosinophil ◽

Blood Eosinophil Count

Background Developing tools to identify chronic rhinosinusitis with nasal polyps (CRSwNP) patients requiring surgical treatment would help clinicians treat patients more effectively. The aim of this retrospective cross-sectional study was to identify cut-off values for eosinophil percentage, nasal polyps (NP), and Lund-Mackay (LM) scores that may predict the need for surgical treatment in Finnish CRSwNP patients. Methods Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001–19 were used. Data was collected from patient records and Lund-Mackay scores were determined from sinus computed tomography scans. The percentage of eosinophils was microscopically evaluated from the polyp samples available (n = 81). Associations were analyzed by Mann Whitney U test, and cut-off values by the area under the receiver operating characteristic curve (AUROC). Results ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was associated significantly with ESS (p = 0.001), whereas peripheral blood eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05). AUROC values (95% CI) for detecting those needing ESS were for polyp eosinophilia 0.71 (0.60–0.83), p = 0.001, for LM score 0.59 (0.50–0.67), p = 0.054; for NP score 0.56 (0.48–0.64), p = 0.17, and for blood eosinophil count 0.68 (0.46–0.90), p = 0.08. With the threshold value of polyp eosinophilia (>25%), the sensitivity and specificity were optimal for detecting the group needing ESS from the group not undergoing ESS. The cut-off value of blood eosinophil count (>0.26 × 109/L) had relatively good, yet statistically insignificant (underpowered), predictive potential. Moderate cut-off values were found for endoscopic LM score (≥14/24) and NP score (≥4/8). Conclusions Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level CRSwNP patients. A future challenge would be to find less invasive and cost-effective clinical factors predicting uncontrolled CRSwNP.

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Blood eosinophil count combined with asthma history could predict chronic rhinosinusitis with nasal polyp recurrence

Acta Oto-Laryngologica ◽

10.1080/00016489.2020.1844288 ◽

2020 ◽

pp. 1-7

Author(s):

Xiaoyan Wang ◽

Yifan Meng ◽

Hongfei Lou ◽

Kuiji Wang ◽

Chengshuo Wang ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyp ◽

Eosinophil Count ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Polyp Recurrence

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Rapid Effect of Benralizumab for Hypereosinophilia in a Case of Severe Asthma with Eosinophilic Chronic Rhinosinusitis

Medicina ◽

10.3390/medicina55070336 ◽

2019 ◽

Vol 55 (7) ◽

pp. 336 ◽

Cited By ~ 4

Author(s):

Tsurumaki ◽

Matsuyama ◽

Ezawa ◽

Koga ◽

Yatomi ◽

...

Keyword(s):

Lung Function ◽

Chronic Rhinosinusitis ◽

Severe Asthma ◽

Nasal Polyps ◽

Oral Corticosteroid ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Eosinophilic Chronic Rhinosinusitis ◽

Rapid Effect ◽

Rapid Treatment

A 56-year-old man with severe asthma underwent bronchial thermoplasty (BT). However, his asthma exacerbated and hypereosinophilia developed 2 months later, thus necessitating oral corticosteroid (OCS) therapy. Six months after BT, a diagnosis of severe asthma with eosinophilic chronic rhinosinusitis (ECRS) was made and benralizumab treatment was initiated; the blood eosinophil count subsequently decreased and lung function improved, thereby permitting OCS dose tapering. Surprisingly, benralizumab both reduced nasal polyps and ameliorated ECRS. Thus, benralizumab may be a useful drug for the rapid treatment of severe asthma with ECRS, especially in patients with hypereosinophilia.

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