We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Histopathologic features of biologic therapy nonresponders in chronic rhinosinusitis with nasal polyposis.
- Authors
Baird, Ali M.; Masliah, Jamie; Filip, Peter; Talati, Vidit; Brown, Hannah J.; Owen, Grant; Khalife, Sarah; Papagiannopoulos, Peter; Gattuso, Paolo; Batra, Pete S.; Tajudeen, Bobby A.
- Abstract
Background: Biologics 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. Methods: A 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. Results: Of 257 CRSwNP patients, 20 were on biologics prior to FESS. Fourteen patients (70.0%) received dupilumab, one (5.0%) receivedmepolizumab, one (5.0%) received omalizumab, and four (20.0%) tried multiple biologics. The mean age for the biologic nonresponder groupwas 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 = 0.019). The remaining 11 variables did not reach statistical significance. Conclusion: Histopathologic 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.
- Subjects
NASAL polyps; SYMPTOM burden; SINUSITIS; BIOTHERAPY; NASAL tumors; BASAL lamina; ENDOSCOPIC surgery; MEDICAL personnel
- Publication
International Forum of Allergy & Rhinology, 2024, Vol 14, Issue 5, p939
- ISSN
2042-6976
- Publication type
Article
- DOI
10.1002/alr.23283