Injection Interval Research Articles

Outlier ophthalmologists in the treatment of neovascular age-related macular degeneration with intravitreal therapy

BackgroundTo compare individual ophthalmologists grouped as outliers or non-outliers based on the mean 12-month visual acuity (VA) outcomes for their patients with neovascular age-related macular degeneration (nAMD).MethodsThis prospectively designed database...

Real-World Long-Term Outcomes of Intravitreal Faricimab in Previously Treated Chronic Neovascular Age-Related Macular Degeneration.

To study the real-world outcomes of intravitreal faricimab (IVF) in longstanding neovascular age-related macular degeneration (nAMD) over a one-year study period. Retrospective single-center cohort study of patients with previously treated nAMD receiving IVF with at least 12 months of follow up. Main outcome measures include injection intervals, visual acuity (VA), and optical coherence tomography features. 263 eyes from 217 patients received 6.4±2.3 IVF injections over one year. Injection interval increased after switching to IVF (5.9±1.8 vs 7.6±2.4 weeks) (p<0.01). There was no improvement in VA after switching to IVF at any time period (p>0.15). Average CST decreased after the first IVF injection and was sustained for one year (313.7±96.0 vs. 288.2±80.6 μm) (p<0.01). There was a statistically significant resolution of subretinal fluid but not IRF at all time points (40.8-50.4%) (p<0.01). Persistent fluid after the first IVF injection was resolved in 34.4% (n=45) by one year. IVF was discontinued in 31 eyes (11.8%), four (1.6%) that experienced intraocular inflammation. Longstanding nAMD eyes switched to IVF experienced a significant extension in injection interval, stable visual acuity, improvement in CST, and resolution of fluid on OCT in many patients over one year.

Safety and Efficiency of Anti-VEGF with Dexamethasone Intravitreal Implant for Non-Ischemic Retinal Vein Occlusion: A Prospective, Case-controlled, Cohort Study.

This study aimed to assess the efficacy and safety of anti-VEGF combined with dexamethasone implant for the retinal vein occlusion patients with macular edema. In this prospective, case-controlled, cohort clinical trial (Register ID: ChiCTR2400080048), patients with non-ischemic retinal vein occlusion were enrolled from the Sanmenxia Central Hospital from August 2020 to April 2023. The patients were randomized into two groups. All the patients received ranibizumab intravitreal injection in the first 3 consecutive months. For the ranibizumab group, anti-VEGF injections were as needed thereafter in case of recurrence of macular edema; For the combination group, the patients received an intravitreal dexamethasone implant injection at 15 days after the first ranibizumab injection. The primary outcome measurements were improvement in best corrected visual acuity (BCVA) and reduction in central macular thickness (CMT). The secondary outcomes were recurrence of macular edema, number of intravitreal injections, and injection interval. Safety profiles were also recorded. A total of 124 patients were included, of which 73 patients completed all follow-ups. Both the ranibizumab monotherapy and the combination therapy significantly improved BCVA at all time points, compared to the baseline. The combined group achieved more BCVA improvement in 3 months, 6 months, and 12 months, compared to the ranibizumab alone group. Compared to the baseline, both groups achieved significant reductions in CMT at all follow-ups. However, the combination group showed more CMT reduction at 1 week post injection, compared to the ranibizumab group. The combination group had a significantly longer injection interval, lower injection time, and recurrence of macular edema. Ocular hypertension was the most common adverse events. Lastly, intraocular pressure was all well controlled by 1-3 glaucoma medications without surgical intervention. The combination therapy could significantly improve the BCVA and reduce the CMT with a good safety profile.

Modified pro re nata regimen of brolucizumab in treatment-naive neovascular age-related macular degeneration.

Purpose- To study the efficacy and safety of pro re nata regimen of brolucizumab, without loading dose, in treatment-naive patients with neovascular age-related macular degeneration (nAMD). Case series- Retrospective, observational study. We included all consecutive patients diagnosed with treatment- naïve nAMD undergoing Brolucizumab in Humanitas eye clinic, Turin, Italy between April 2022 and May 2023. Treatment was performed following pro re nata regimen without loading phase. Injection intervals (time between two injections), adverse events, changes in best corrected visual acuity (BCVA), central macular thickness (CMT), maximal retinal thickness (MRT), intraretinal and subretinal fluid (IRF, SRF) were evaluated descriptively up to one year after the first injection. Twenty-one eyes of 21 patients were included in the study. The mean number of injections was 2.4±0.7 at 3 month, 3.0±2.0 at 6 month, 3.1±2.4 at 9 month and 3.8±2.8 at 12 month, respectively. BCVA significantly improved from 20/80 Snellen (0.6±0.3 LogMar) to 20/50 Snellen (0.4±0.3 LogMar) at month 12 (p = 0.044). CMT and MRT significantly reduced from 426 μm and 606 μm at baseline, to 248 μm and 356 μm at one-year follow-up (p=0.00067 and p=0.02, respectively). SRF and IRF also progressively resolved. On the other hand, intraocular inflammation (IOI) events occurred in 9.5% of cases during follow-up. IOI resolved in all cases with prompt treatment without visual sequelae. Conclusions- In our study, pro re nata regimen of brolucizumab without loading phase appears to be an effective treatment option in treatment-naive nAMD patients, with IOI rate similar to the one reported in trials and lower number of injections.

Implementation strategy of insulin therapy under sparse state feedback

Traditional continuous glucose monitoring is often costly and inconvenient, necessitating more efficient methods. This paper proposes a novel approach to diabetes management by utilizing sparse monitoring data for insulin injection decisions. A differential equation-based model is developed to estimate plasma glucose levels and optimize insulin dosages and injection intervals using limited feedback data. This method ensures that glucose levels remain within a safe range. Numerical simulations demonstrate the effectiveness of this approach, offering a viable alternative for improving diabetes management.

Quantifying cost-savings in the treatment of neovascular age-related macular degeneration in Aotearoa New Zealand.

To estimate the cost-impact if faricimab were approved for the treatment of neovascular age-related macular degeneration (nAMD) in New Zealand. A retrospective, single-centre cost-analysis study. Data on intravitreal agent and injection intervals were obtained and statistically compared. Cost estimates were based on internal facility and publicly available data. The current costs of care were compared to two scenarios: one where all eyes receive faricimab, and another where eyes receiving aflibercept switch to faricimab. A total of 352 eyes from 292 patients were analysed. Present values locally over 10 years were estimated at -$6,776,340 for the first scenario and $5,015,922 for the second, releasing 252 and 176 hours of clinical time per year, respectively. Nationally, the savings extrapolated to -$187,925,737 and $139,104,706, respectively. The analysis indicates significant direct cost savings for the health sector and potential reductions in patient harm due to fewer injections. The approval of faricimab for the treatment of nAMD could result in substantial direct cost savings for the health sector. Additional benefits include reducing patient harm and improving ophthalmic health inequalities for Māori and Pacific peoples. Further research in diverse patient populations across multiple centres is needed to estimate the magnitude of cost savings more accurately. This study highlights the potential of faricimab to alleviate the treatment burden and provide a more sustainable healthcare option for nAMD in New Zealand, especially in cases of recalcitrant nAMD, if used in a tailored and patient-specific manner alongside the existing armamentarium of treatments.

Fluid Resolution Without Shortening Injection Interval During Subretinal Fluid-tolerating Treatment in Neovascular Age-related Macular Degeneration.

To investigate the incidence and factors associated with subretinal fluid(SRF) resolution during SRF-tolerating treatment in patients with neovascular age-related macular degeneration(AMD). This retrospective study included patients diagnosed with neovascular AMD who exhibited fovea-involving residual SRF persisting for at least 6 months during aflibercept treatment. Patients who showed SRF resolution despite maintaining the injection intervals were included in the resolution group, while those who exhibited persisting SRF throughout the study period were included in the non-resolution group. The incidence and associated factors of SRF resolution without reducing the injection interval were evaluated. Furthermore, the frequency of successfully extending the injection intervals while maintaining SRF resolution was identified. In total, 65 patients with neovascular AMD were included(32 and 33 in the resolution and non-resolution groups, respectively). When compared to the non-resolution group, the resolution group showed a lower mean height of SRF(67.7±33.4 vs 109.9±44.9 µm, P<0.001) and a lower maximum height of SRF(138.3±88.6 vs 176.2±76.9 µm, P=0.034). In multivariate analysis, the mean SRF height(P=0.001), maximum SRF height(P=0.006), and interval of anti-vascular endothelial growth factor injections(P=0.023) were significantly associated with the resolution of SRF. In the resolution group, 14 patients(43.8%) successfully expanded the injection interval. During SRF-tolerating treatment for neovascular AMD, a substantial proportion of patients exhibited resolution of fluid without shortening the injection interval. Patients with lesser residual SRF during treatment were more likely to achieve fluid resolution. Following SRF resolution, injection intervals can be extended in more than 40% of patients.

Faricimab versus bevacizumab for neovascular age-related macular degeneration: Cost analysis based on real-world data from the Swedish Macula Registry.

To analyse the impact on cost if faricimab is used as the first-line treatment for neovascular age-related macular degeneration (nAMD) compared to standard treatment with bevacizumab. Retrospective registry study including real-world data from the Swedish Macula Registry between 2017 and 2022. The observed number of injections and visits for bevacizumab during the first two years of treatment was used (n = 437 patients). Number of faricimab injections was obtained from published clinical trial data and unit costs mostly from publicly available Swedish sources. The provider cost included medication and visit cost and societal cost included additionally patient travel cost. Costs are presented in 2023 EUR. The incremental societal cost of faricimab was 277 EUR per patient compared to bevacizumab in the base case. Medication cost was higher (1516 EUR) while visit cost (-1183 EUR) and patient travel cost (-56 EUR) were lower due to longer injection intervals. Faricimab was of similar cost as bevacizumab for patients residing far from the clinic. The faricimab injection interval and the number of bevacizumab injections were major drivers of uncertainty in the results. Faricimab represents a cost-effective alternative to bevacizumab for patients with nAMD in Sweden. Its extended treatment interval is particularly beneficial for patients living far from clinics, and if the real-life faricimab injection interval extends beyond 12 weeks. Our findings emphasize faricimab's potential to free up healthcare staff to treat a larger patient population with existing clinic resources.

Study on the impacts of injection parameters on knocking in HPDI natural gas engine at different combustion modes

Based on three-dimensional (3D) computational fluid dynamics (CFD) software, a 3D numerical model was constructed to investigate the effects of injection timing, pilot diesel energetic ratio (PDER), and angle between the central axis of the diesel jet and the horizontal direction (α) on combustion and knock in the natural gas mixing-limited combustion (NMLC) mode and natural gas slightly premixed combustion (NSPC) mode. The results indicate that advancing the start of injection of natural gas (NSOI) leads to a slight improvement in indicated thermal efficiency (ITE), but also an increase in peak cylinder pressure (Pmax) and maximum pressure rise rate (MPRR). In the NMLC mode, as the diesel and natural gas injection interval (IDN) decreases, the interference between the diesel and natural gas jets intensifies, ultimately leading to instability in the flame propagation process and increased fluctuations in cylinder pressure. At different NSOIs, when IDN is 0°CA, the maximum amplitude of pressure oscillations (MAPO) is the highest. When the PDER is increased from 5 % to 15 %, ITE increases by 7.1 %. Under different combustion modes, as α increases, ITE first increases and then decreases. However, the NSPC mode achieves a higher ITE, reaching up to 44.4 %.

Intravitreal therapy in neovascular age-related macular degeneration-adapting to increasing demand and changing times.

To report the outcomes of patients with neovascular age-related macular degeneration (nAMD) at Palmerston North Eye Clinic (PNEC) during 2020 and 2021, comparing time to treatment initiation based on nurse-injector availability and during COVID-19 restrictions. Data were recorded from a prospective database for patients with nAMD at PNEC. Each patient's electronic health record was reviewed to ensure the accuracy of the database and to fill in missing data points. Statistics were done using Microsoft Excel and R. One hundred and fifty-six eyes were diagnosed with nAMD during the study. Mean time from referral triage to first injection was 13.08 days across the study period. Time to treatment initiation was not statistically different by level of COVID-19 restriction but there was a significant difference in first specialist appointment to injection interval when three nurse-injectors were available compared to four. The effect seemed most evident in subsequent months after reduced nurse-injector availability began. Despite an increase in nAMD diagnoses each year, PNEC continues to meet national guidelines for interval from referral to treatment initiation through innovations in practice. As demand for intravitreal injections continues to increase, further resourcing and research into newer agents will be required to keep wait times compliant with guidelines.

Visual and Anatomic Responses in Patients With Neovascular Age-Related Macular Degeneration and a Suboptimal Response to Anti-VEGF Therapy Switched to Faricimab.

Purpose: To determine the efficacy of switching to intravitreal (IVT) faricimab in patients with treatment-resistant neovascular age-related macular degeneration (nAMD) and determine the rates of reversion to original antivascular endothelial growth factor (anti-VEGF) therapy. Methods: A retrospective chart review was performed of patients with nAMD and persistent fluid on optical coherence tomography previously treated with anti-VEGF injections who received at least 1 IVT faricimab injection between March 1, 2022, and January 31, 2023. Results: The study comprised 135 eyes of 119 patients. Before switching to IVT faricimab, the mean number of anti-VEGF injections in the previous 12 months was 10.7 ± 2.6 (SD) with a mean interval of 4.8 ± 1.3 weeks (range, 2-8). The mean follow-up was 11.6 ± 2 months. Thirty eyes (22.2%) switched to IVT faricimab returned to the original therapy. Of 105 eyes remaining on IVT faricimab, 66 (62.9%) had no fluid at the last follow-up. Compared with the original treatment, there was a significant improvement in logMAR visual acuity at the last follow-up in eyes on IVT faricimab (0.42 vs 0.38; P < .01) and in central subfield thickness (286 µm vs 246 µm; P < .0001). There was also a significant increase in the dosing interval after the third injection vs before IVT faricimab was prescribed (4.8 weeks vs 5.5 weeks; P < .001). Conclusions: Faricimab has a potent drying effect and potential for increasing the injection interval in many eyes with nAMD and persistent fluid on other anti-VEGF agents. Although nearly 25% of eyes reverted to the original therapy because of an insufficient response or adverse events, the majority did not achieve fluid resolution after reversion.

Inertial flow-induced fluid pressurization enhances the reactivation of rate-and-state faults

We reveal that inertial flow can introduce additional pressure perturbations which accelerate the instability of critically stressed faults. We integrate a poroelastic spring-slider model with rate-and-state friction (RSF), a nonlinear flow model characterized by the improved Izbash equation, and a universal visco-inertial permeability model. The effect of inertial flow depends on the fracture network properties, proximity to faults, and injection parameters. Significant inertial flow results in higher pressure magnitudes and pressurization rates, causing notable differences in predictions between linear and nonlinear flow models, as well as aging and slip laws. The impact of inertial flow is particularly pronounced within a specific permeability range and is enhanced by high-rate injections. The fault reactivation is delayed due to fault strengthening with RSF in response to increased pressurization rates. Conversely, the presence of inertial flow enhances fault reactivation and promotes unstable slip behaviors. Furthermore, the results demonstrate that cyclic injection increases the critical stiffness of faults without an adequate release of pore pressure in each cycle. The time interval of the cyclic injection is prolonged as inertial flow generates higher pressure levels. This study highlights the importance of inertial flow in the stability analysis of critically stressed faults.

Brolucizumab-associated intraocular inflammation in Indian patients by VRSI study group.

Concerns about brolucizumab's (Pagenax®) association with intraocular inflammation (IOI) limit its use despite its cost-effectiveness and efficacy. This multicentric study analyzes IOI incidence across 21 tertiary eyecare centers in India since its introduction in October 2020. To determine the real-world incidence rate of IOI in Indian patients secondary to intravitreal brolucizumab across 21 tertiary eye care centers in India. Retrospective multicentric, survey-based study. Data including number of patients treated, clinical indications, side effects encountered, and IOI case details was collected via Google Forms in 21 Indian tertiary eye care centers since October 2020. Mean, median, frequency, and standard deviation were calculated for statistical analysis. All centers used pro re nata protocol for brolucizumab injections with a minimum injection interval of 8 weeks. The incidence of IOI was 0.79% (21 events out of 2655 eyes). Treatment indications included idiopathic polypoidal choroidal vasculopathy, neovascular age-related macular degeneration, diabetic macular edema, and off-label uses. IOI was experienced after the first injection (57%) in majority of cases with a median onset of 14 days (range: 1-65 days). IOI was mild in 28.5%, moderate in 33%, and severe in 38% of cases. Eighteen out of 21 IOI eyes recovered preinjection best corrected visual acuity or better. Our study found a lower IOI incidence (0.79%) with brolucizumab (Pagenax) in Indian patients compared to previously reported literature. IOI events were mostly mild to moderate, and post-treatment, most patients improved or maintained BCVA. Larger prospective multicentric studies with PRN dosing protocol are needed to confirm these findings.

Effect of pre-injection strategy on the reduction of exhaust emissions from n-pentanol/biodiesel engine

N-pentanol can be used as an additive component of biodiesel to achieve NOx and soot emission reductions while improving the low-temperature fluidity of biodiesel. This paper investigates the mechanism of pre-injection strategies (pre-main injection interval and pre-injection ratio) on the emission characteristics of n-pentanol/biodiesel engines. It extends the study to investigate the effect pattern of pre-injection strategies on formaldehyde emissions. The results show that the emission characteristics of the n-pentanol/biodiesel engine can be effectively improved by using a pre-injection strategy compared to a single injection. With the pre-main injection interval increase, the in-cylinder combustion stability was improved, and the generation of NOx and soot was effectively suppressed. Compared to a single injection, a pre-main injection interval of 15 °CA resulted in a 15.38 % decrease in CA50 and an 18.32 % increase in IMEP. Meanwhile, the increase of the pre-main spray interval broke the trade-off relationship between NOx and soot, and when the main pre-spray interval was increased from 15 °CA to 30 °CA, Soot and NOx generation were reduced by 27.46 % and 21.30 %, respectively. As the proportion of pre-injection increases, the center of gravity of combustion is shifted forward, the combustion exotherm is more concentrated, and the soot emission is significantly reduced. When the percentage of pre-spray was increased from 0 % to 20 %, CA50 decreased by 19.23 %, IMEP increased by 1.32 %, and soot generation decreased by 61.02 %. When the proportion of pre-spray was increased from 15 % to 20 %, CH2O emissions were reduced by 14.81 %.

Switching to Intravitreal Brolucizumab after Ranibizumab or Aflibercept Using Treat and Extend Regimen for Neovascular Age-Related Macular Degeneration in Japanese Patients: 1-Year Results and Factors Associated with Treatment Responsiveness.

Objective: To purpose of this study was to retrospectively evaluate the 1-year outcomes and factors associated with the treatment responsiveness of switching to intravitreal brolucizumab (IVBR) for neovascular age-related macular degeneration (nAMD) in Japanese patients refractory to ranibizumab or aflibercept using a treat and extend (TAE) regimen. Methods: A total of 48 eyes of 47 nAMD patients were switched to IVBR, and 36 eyes of 35 patients (27 males and 8 females) underwent 1-year treatment after the switch. Results: The rate of dry macula was significantly higher 12 months after the switch to IVBR (p < 0.001), with a significant decrease in the mean central macular thickness (CMT) and the mean central choroidal thickness (CCT) (p < 0.01 and p < 0.01, respectively). The injection interval was significantly extended from 7.0 ± 1.7 weeks to 10.3 ± 2.5 weeks 12 months after the switch (p < 0.001). In the multivariate analysis, a smaller number of prior anti-VEGF injections (p = 0.025; odds ratio: 0.947; 95% confidence interval: 0.903-0.994) and a pre-switching CCT of less than 250 µm (p = 0.023; odds ratio: 0.099; 95% confidence interval: 0.013-0.731) were associated with the good response group. Conclusions: These results suggest that IVBR may suppress disease activity and prolong the injection interval by switching for AMD patients with an insufficient response to treatment with ranibizumab and aflibercept.

Characterization of omalizumab updosing patterns and predictive factors in chronic spontaneous urticaria: A prospective multicentric observational study.

Limited information is available on the use of omalizumab (OMA) updosing since its introduction as a second-line therapy in chronic spontaneous urticaria (CSU) in 2014. Practical guidelines from health authorities are lacking, and the specific characteristics of patients requiring higher doses remain unknown. Our objectives were to characterize the patterns of OMA updosing (defined as changes in dose and/or injection intervals), to identify the predictive factors associated with updosing, and to improve CSU management. We conducted a prospective, multicentric, real-life observational study, including patients diagnosed with CSU and starting OMA. The data were collected at 0, 3, 6, and 9 months. The primary endpoint was the frequency of OMA updosing at 3 months. The secondary endpoints included an analysis of updosed patients' profile, and an assessment of OMA efficacy and safety. We included 153 patients. Twenty percent of patients were updosed at 3 months, and 27% in total during the 9-month follow-up. Practitioners mainly chose to increase the frequency of injections (66%). At baseline, the updosed patients were more likely to have more severe CSU (UCT < 4, p < 0.030), a lower lymphocyte count (<2000/mm3, p = 0.037), and low IgE levels (<70 UI/mL, p = 0.024). The side effects of OMA were not more frequent after updosing. One in five patient underwent updosing within just 3 months. OMA updosing is frequent in particular in cases of severe disease and low IgE blood levels.

Impact of COVID-19 on a real-world treat-and-extend regimen with aflibercept for neovascular age-related macular degeneration

ObjectiveTo assess the effect of the COVID-19 pandemic on injection intervals among patients treated for neovascular age-related macular degeneration. DesignRetrospective cohort study. ParticipantsPatients treated at a single practice using a treat-and-extend regimen with intravitreal aflibercept between December 2018 and April 2021. MethodsThe primary outcome was the change in injection intervals. Secondary outcomes included differences in best-recorded visual acuity (BRVA) and central subfield thickness (CST). Associations were evaluated with linear mixed-effects modelling. ResultsThis study included 1839 injections from 185 eyes (141 patients). The median (interquartile range) injection intervals in the pre-COVID-19 and COVID-19 periods were 60 (42–70) and 70 (49–90) days, respectively. The pandemic was associated with a mean injection interval lengthening of 7.2 days (P < 0.001), a decrease in BRVA of 3.1 Early Treatment Diabetic Retinopathy Study letters (P < 0.001), and a reduction in CST of 14.7 μm (P = 0.003). The presence of exudative intraretinal fluid was associated with a reduction in treatment intervals of 11.1 days (P < 0.001), a reduction in BRVA of 1.9 Early Treatment Diabetic Retinopathy Study letters (P < 0.001), and an increase in CST of 52.4 μm (P < 0.001). The presence of subretinal fluid was associated with a reduction in treatment intervals of 8.5 days (P < 0.001) and an increase in CST of 21.6 μm (P < 0.001). ConclusionsThis real-world study estimated that the severe acute respiratory syndrome coronavirus 2 pandemic resulted in an injection extension of 7.2 days with associated decreases in BRVA and CST that are unlikely clinically significant on a population basis. This builds on evidence suggesting that long-term vascular endothelial growth factor suppression can facilitate meaningful interval extensions while maintaining visual acuity.

Numerical Simulation on Combustion Characteristics of Methane Air Premixed Flame Impacted by Hydrogen jet

Abstract Low-concentration coalbed methane is an efficient and clean unconventional natural gas with abundant reserves. It can greatly lessen the problem of energy scarcity when used to produce combustion power. Nevertheless, the engine finds it challenging to burn the CH4 directly due to its low and fluctuating concentration. This study suggests using a hydrogen jet to ignite low-concentration coalbed methane. The simulation method is used in this paper. To investigate the effects of various ignition injection strategies on the combustion characteristics of low concentration coalbed methane ignited by a hydrogen jet, a constant volume bomb model was developed. The results show that when the ignition and hydrogen injection interval is 2.0 ms, the cold jet of hydrogen does not burn immediately when it reaches the premixed flame, and there is a transition process from the premixed flame to the jet flame. The larger the interval between ignition and hydrogen injection, the more waste gas is produced after the premixed flame combustion, which has a certain inhibition effect on the formation of the jet flame. With the decrease in the interval between ignition and hydrogen injection, the combustion duration is obviously shortened. Therefore, the earlier hydrogen is involved in the ignition, the faster the combustion speed.

The use of biologics in patients suffering from chronic rhinosinusitis with nasal polyps - a 4-year real life observation.

Antibody therapy for chronic rhinosinusitis with nasal polyps (CRSwNP) has been established in Germany since 2019. With limited long-term data on biologic treatment for CRSwNP, we conducted a comprehensive evaluation of our 4-year data. This monocentric study aims to assess the real-world effects of this treatment on clinical course, quality of life, treatment adherence, biologic switching, dual therapy, and comorbidities. We retrospectively analysed biologic therapy data in patients with severe chronic rhinosinusitis with nasal polyps. 191 patients with CRSwNP treated with Dupilumab, Mepolizumab, or Omalizumab were observed for up to 4 years in a real-life setting. We observed clear symptom improvements with few side effects. No loss of efficacy or tolerability was noted during the 4-year period. Patients reported high satisfaction compared to previous therapies, with overall improved quality of life. Revision surgery or oral steroid use during biologic therapy was rare. Some patients prolonged injection intervals or discontinued steroid nasal spray. Biologic switching occurred infrequently due to side effects or inadequate response and was generally well tolerated. Many patients reported additional positive effects such as asthma or allergy symptom improvement and reduced medication intake. In summary, this study confirms the potency and tolerability of biologics for CRSwNP treatment, with sustained efficacy over 4 years. Biologic switching is a viable option for inadequate response or intolerable side effects. Therapy positively impacts Th2 comorbidities, corticosteroid requirements, surgery need, and overall compliance remains high. Project No.: 22-0802. Registry name: Biologika bei Patient*innen mit chronischer Sinusitis mit Nasenpolypen.

Additional injection laryngoplasty as a salvage treatment for unilateral vocal fold paralysis.

Injection laryngoplasty (IL) has been widely used as an initial treatment option for unilateral vocal fold paralysis (UVFP). An additional (second) IL is considered a salvage treatment for unsatisfactory outcomes of initial IL resulting from inadequate injection or early resorption of the injection material. This study aims to evaluate the efficacy of additional IL, distinguishing between "salvage" (within 4 months) and "repeated" injections (beyond 4 months), and to analyze prognostic factors for successful outcomes. This retrospective study involved patients who received IL at Asan Medical Center from January 2014 to December 2020. Voice parameters were collected after each procedure, and those who conducted the statistical analysis were blinded to the study subjects. Among the 65 patients who underwent additional IL, 51 patients were enrolled in this study. Postinjection grade, roughness, breathiness, asthenia, strain (GRBAS) scales were used to determine satisfactory treatment outcomes. Success of the additional IL was defined as a postinjection grade of dysphonia score of 0 or 1, with a reduction in grade compared with the preinjection grade. The mean age of the patients was 61.6 years. Out of a total of 51 patients, 37 were men participating in the study. The odds ratio represents the likelihood of success in the second IL. Improved voice outcome after the additional IL was maintained in 23 (45%) patients. Compared with the failure group, the success group had a longer injection time interval between the initial and additional injection (9.1 vs. 7.4 months, respectively, p = 0.010). The success group had a higher proportion of patients with injection intervals >6 months (73.9% vs. 42.9%, p = 0.026). Logistic regression analysis revealed an injection interval >6 months had an odds ratio of 0.265 (confidence interval: 0.080-0.874, p = 0.029). Additional injections would benefit the patients whose voice outcomes are maintained for a longer period (>6 months) after the first injection.