Abstract
PurposeAspirin treatment after desensitization (ATAD) represents an effective therapeutic option suitable for NSAID-exacerbated respiratory disease (N-ERD) patients with recalcitrant disease. Intranasal administration of lysine-aspirin (LAS) has been suggested as a safer and faster route than oral ATAD but evidence for its use is less strong. We investigated nasal LAS therapy long-term efficacy based on objective outcomes, smell function, polyp recurrence and need for surgery or rescue therapy. Clinical biomarkers predicting response to intranasal LAS, long-term side effects and consequences of discontinuing treatment have been evaluated.MethodsA retrospective analysis of a database of 60 N-ERD patients seen between 2012 and 2020 was performed in March 2021. They were followed up at 3-months, 1-, 2- and 3-years with upper and lower airway functions assessed at each follow-up.ResultsHigher nasal airflow and smell scores were found at each follow-up in patients taking LAS (p < 0.001 and p = 0.048 respectively). No influence of LAS on pulmonary function measurements was observed. Patient on intranasal LAS showed a lower rate of revision sinus surgery when compared to those who discontinued the treatment (p < 0.001). None of the variables studied was found to influence LAS treatment response.ConclusionOur study demonstrates the clinical effectiveness of long-term intranasal LAS in the management of N-ERD in terms of improved nasal airflow and olfaction and a reduced need for revision sinus surgery. Intranasal LAS is safe, being associated with a lower rate of side effects when compared to oral ATAD. However, discontinuation of the treatment at any stage is associated with a loss of clinical benefit.
Highlights
Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD), referred to as Samter’s triad, remains a diagnostic and therapeutic challenge [1].London, UK 4 Department of Statistical Sciences and Department of Mathematics Tullio Levi‐Civita, University of Padua, Padua, ItalyStandard treatments include the use of nasal corticosteroids, nasal douches, inhalers, leukotriene-modifying drugs, and biologics targeting type 2 inflammatory cytokines [2]
A further 19 patients did not show any reaction to the escalating aspirin dose at the challenge and were excluded from the study leading to a final population of 80 NSAIDexacerbated respiratory disease (N-ERD) patients who were asked to start on intranasal LAS as part of their treatment
This reflects previous results obtained with oral Aspirin treatment after desensitization (ATAD) both in the short- and in the long-term despite using a consistently higher dose of daily aspirin (300 mg/day–650 mg twice/day) [21,22,23,24], whereas no significant differences in endoscopic polyp scores have been reported by an randomized-controlled trial (RCT) in patients on low-dose oral aspirin (100 mg/day) [25]
Summary
Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD), referred to as Samter’s triad, remains a diagnostic and therapeutic challenge [1]. Standard treatments include the use of nasal corticosteroids, nasal douches, inhalers, leukotriene-modifying drugs, and biologics targeting type 2 inflammatory cytokines [2]. Patients with N-ERD tend to undergo up to 10-times more revision ESS and are more likely to be dependent on oral corticosteroids to control their disease [3]. Aspirin treatment after desensitization (ATAD), whereby a patient is exposed to a gradually increasing dose of aspirin until a final daily dose is reached, has emerged as an effective therapeutic option suitable for N-ERD patients with recalcitrant disease [1]. Since its first description in 1980 [4], several blinded and longitudinal studies have consistently shown the benefit of ATAD including a decrease in sinonasal symptoms (Grade 1A), decrease in intranasal
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