Systematic Review of Omalizumab for the Treatment of Chronic Rhinosinusitis

Abstract

S A T U R D A Y 174 Omalizumab for the Treatment of Chronic Rhinosinusitis: A Multi-Disciplinary Practice Review Shaun Kilty, MD, FRCSC, Andrea Lasso, Stephanie Santucci, RN, William H. Yang, MD; Ottawa Hospital Research Institute, Ottawa, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada, Allergy and Asthma Research Centre, Ottawa, ON, Canada, University of Ottawa Medical School, Ottawa, ON, Canada. RATIONALE: Recently, anti-IgE monoclonal antibody has emerged as a potential therapy for CRS. However, to date evidence for its efficacy in this patient population is sparse. The purpose of this study is to evaluate the clinical treatment effect of omalizumab therapy for patients with recalcitrant CRS treated in a multi-disciplinary clinic. METHODS: The charts of 194 patients on omalizumabwere reviewed. 21 patients diagnosed with CRS and having failed surgical and/or medical therapy were identified. Data extraction was performed and targeted demographic details, asthma, environmental allergy and CRS specific disease related data including self-reported major symptom improvement. Nonparametric data was analysed with the Mann-Whitney test and binary data was analysed with Fisher’s exact test. RESULTS: Themean treatment durationwas17months.Themost common skin test positive environmental allergens were dust mites (100%) and cats (65%). 75% of the cohort had CRS with polyps. Six patients (30%) had AERD.Themeanpolyp score decreased from1.8 to 1.0 (p50.106). From the time of treatment initiation to the last omalizumab treatment dose, patients reported a mean 59% improvement in their olfaction, a mean 70.4% improvement in facial pain, a mean 78.2% improvement in nasal obstruction and a mean 68.1% improvement in the symptom of rhinorrhea. Patients reported a mean overall improvement in their sinus symptoms of 74.1%. CONCLUSIONS: Omalizumab therapy provided a substantial improvement in the self-reported major symptom control for patients with recalcitrant CRS and asthma. Awell-designed comparative study is needed to further assess its effectiveness in the CRS population.