D1.143 - Clinical Efficacy of Biologics and ATAD in NSAID-Exacerbated Respiratory Disease: A Phenotype-Based Comparative Study

The emergence of biologics has challenged the traditional role of aspirin therapy after desensitization (ATAD) in treating NSAID-exacerbated respiratory disease (N-ERD), raising the million-dollar question: “Which treatment is right for which patient?” However, comparative efficacy data and phenotype-based strategies remain scarce. To compare the efficacy of omalizumab, mepolizumab, benralizumab, ATAD, and their combinations in N-ERD, and to propose phenotype-based treatment recommendations.

This retrospective study included 70 adult patients diagnosed with N-ERD who had received treatment for at least six months. Outcomes included Asthma Control Test (ACT), Sino-Nasal Outcome Test (SNOT-22), smell/taste score, blood eosinophils, oral corticosteroid (OCS) use, and emergency department (ED) visits. Phenotypes were identified via hierarchical clustering using Factor Analysis for Mixed Data (FAMD) and Ward’s method.

Gender (V = 0.10), age (η² = 0.005), and body mass index (ε² = 0.001) were similar across treatment groups. Improvements were observed in SNOT-22 (effect size [ES]=2.0), eosinophils (ES=1.6), ACT (ES=–2.1), OCS use (ES=1.0), loss of smell or taste score (ES=0.7), and ED visits (ES=0.3) in the ATAD + biologic group; SNOT-22 (ES=1.76), ACT (ES=2.31), and OCS use (ES=0.86) in the omalizumab group; eosinophils (ES=2.81) and ED visits (ES=0.69) in the benralizumab group; and loss of smell or taste score (ES=0.88) in the mepolizumab group. Among the three phenotype groups identified through hierarchical clustering, Cluster 1 benefited most from ATAD + biologic, Cluster 2 from biologics, and Cluster 3 from ATAD.

Each treatment demonstrated specific benefits, but combination therapy provided the most comprehensive clinical outcomes. Phenotype-guided strategies may optimize therapeutic decisions: ATAD for mild, biologics for moderate, and combination therapy for severe phenotypes.