D1.157 - Response to biologic therapy in severe asthma and chronic rhinosinusitis with nasal polyps according to nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity

In patients with airway diseases, coexisting NSAID hypersensitivity may be associated with a more complex clinical presentation and increased inflammatory activity. In routine clinical practice, this is often linked to poorer disease control and increased need for treatment escalation with conventional therapies. Whether NSAID hypersensitivity influences the effectiveness of targeted biologic treatments in this population remains unclear.

We conducted a real-world observational study in a tertiary referral center including patients treated with biologic therapies for severe asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP). Biologic agents included mepolizumab, benralizumab, tezepelumab, dupilumab, and omalizumab, prescribed according to local reimbursement criteria.Baseline assessment comprised asthma control (Asthma Control Questionnaire, ACQ), asthma-related quality of life (miniAQLQ), lung function (FEV1 % predicted), and sinonasal symptom burden (SNOT-22). NSAID hypersensitivity was assessed based on clinical history.Asthma-related outcomes were analyzed exclusively in patients with asthma, while sinonasal outcomes were analyzed exclusively in patients with CRSwNP. Treatment effectiveness was evaluated using changes (Δ) between baseline and a follow-up assessment performed approximately 6 months after treatment initiation. Comparisons between patients with and without NSAID hypersensitivity were performed using non-parametric statistical methods.

A total of 114 patients were included; 104 had asthma and 94 had CRSwNP, with 84 patients affected by both conditions. Baseline age, asthma control, lung function, asthma-related quality of life, and sinonasal symptom burden were comparable between patients with and without NSAID hypersensitivity, although female sex was more prevalent among NSAID-hypersensitive patients.Biologic therapy was associated with significant improvement in asthma control, asthma-related quality of life, lung function, and sinonasal symptoms in the overall cohort. There was no statistically significant difference in improvement between patients with and without NSAID hypersensitivity for asthma-related outcomes (ΔACQ, ΔminiAQLQ, ΔFEV1) or sinonasal outcomes (ΔSNOT-22).

In this real-life tertiary-care cohort, biologic therapy was effective in improving both lower and upper airway outcomes in patients with severe asthma and CRSwNP. NSAID hypersensitivity did not affect the response to biologic treatment, suggesting that this phenotype does not limit the effectiveness of biologic therapies in routine clinical practice.