Real-Life Experience of Monoclonal Antibody Treatments in Chronic Rhinosinusitis with Nasal Polyposis

<b><i>Introduction:</i></b> Few studies assess biologicals such as, omalizumab, mepolizumab, benralizumab, and dupilumab in patients suffering from chronic rhinosinusitis with nasal polyposis (CRSwNP). The reported success rate in these studies differ, and it remains uncertain if there are any biomarkers to predict successful therapy. Our aim was to analyze the therapeutic outcome in a real life setting and to identify predictive biomarkers for successful treatment. <b><i>Methods:</i></b> Data from patients with CRSwNP treated with a monoclonal antibody between November 2014 and January 2020 were analyzed retrospectively. Improvement in the polyp score and clinical symptoms like nasal obstruction, sense of smell, nasal discharge, and facial pain were evaluated. Other characteristics, including use of nasal or systemic steroids, comorbidities, previous history of sinus surgery, eosinophilia tissue, blood values (eosinophils, total immunoglobulin E, eosinophilic cationic protein, and interleukin 5), and allergic sensitization in serum were also investigated to identify possible predictive biomarkers. <b><i>Results:</i></b> Forty-eight treatments in 29 patients (m/f = 15/14) aged 27–70 years were reviewed. Treatments with mepolizumab showed the best success rates (78.9%), followed by omalizumab (50%) and benralizumab treatments (50%). However, a correlation between biomarkers and treatment success could not be found. <b><i>Discussion/Conclusion:</i></b> Treatment of CRSwNP with biologicals is a promising option for severe cases not responding to conventional therapy, including difficult-to-treat patients. Predictive biomarkers for a successful treatment could not be identified, but the reduction of eosinophilic cationic protein was linked with the response.

Eosinofilik Otitis Media

<div class="WordSection1"><p class="Body"><strong>Abstrak</strong><strong></strong></p><p><strong>Pendahuluan: </strong>Eosinofilik otitis media (EOM) merupakan otitis media yang sulit disembuhkan dengan karakteristik adanya cairan efusi berwarna kuning pada telinga tengah dengan viskositas tinggi yang mengandung akumulasi eosinofil yang luas. Onset EOM terjadi pada dekade kelima dengan perbandingan prevalensi eosinofilik otitis media pada wanita dan pria, yaitu sebesar 2 : 1. Pasien dengan EOM akan menunjukkan penurunan pendengaran yang bertahap atau cepat. <strong>Tujuan:</strong>Mengetahui dan memahami EOM.<strong>Tinjauan Pustaka:</strong>EOM dikaitkan dengan pasien yang menderita asma bronkial, polip nasal dan pasien dengan intoleransi aspirindengan ditemukannya peningkatan jumlah IgE pada mukosa telinga tengah. Pada EOM, eosinofil yang teraktivasi akan melepaskan protein sitotoksik yang disebut dengan <em>eosinophilic cationic protein </em>(ECP). Eosinofil dapat bermigrasi dan merusak telinga bagian dalam melalui <em>round window</em>. <strong>Kesimpulan: </strong>Ditemukannya eosinofil pada mukosa dan cairan efusi telinga tengah akan menyebabkan degranulasi dan dilepaskannya ECP. Produksi berlebihan dari IgE pada mukosa telinga tengah berhubungan dengan kondisi patologis dari EOM sebagai respon tipe lambat yang dimediasi IgE. Kondisi ini dapat menyebabkan kerusakan telinga bagian dalam dan berujung pada gangguan pendengaran berupa tuli sensorineural.<strong>Kata Kunci:</strong>Eosinofilik otitis media, eosinofil, IgE, ECP, tuli sensorineural</p><p class="Body"> </p><p class="Body"><strong><em>Abstract</em></strong><strong><em></em></strong></p><p class="Body"><strong><em>Introduction:</em></strong><em>Eosinophilic otitis media (EOM) is an intractable otitis media characterized by the presence of a highly viscous yellow effusion with extensive accumulation of eosinophils in the middle ear. The age at the onset of EOM is approximately in the fifties and the female and male ratio is about 2 : 1. Eosinophilic otitis media patients show gradual or sudden deterioration of hearing.</em><strong><em>Objective: </em></strong><em>Determining and understanding the EOM. </em><strong><em> Literature Review:</em></strong><em>EOM associated with adults with bronchial asthma, nasal polyps and aspirin-intolerance by finding the elevation of IgE accumulation in the middle ear mucosa. In EOM patient, eosinophil releases cytotoxic protein called </em><em>eosinophilic cationic protein (ECP).</em><em>Eosinophil will migrate and eventually cause inner ear damage through round window. </em><strong><em>Conclusion:</em></strong><em></em><em>Most of eosinophils in the middle ear mucosa and middle ear effusion were activated, resulting in degranulation and release of ECP. Local IgE over production indicating that the intractable inflammation is closely associated with IgE-mediated late phase response. This condition will damage inner ears and can cause<strong></strong>sensorineural hearing loss.<strong> </strong></em></p><p class="Body"><strong><em>Keywords</em></strong><strong>:<em></em></strong><em>Eosinophilic otitis media, eosinophil, IgE, ECP, sensorineural hearing loss</em></p></div>