D3.128 - Management of Nasal Polyposis in Moderate-Severe Asthma Patients With Aspirin Desensitization And Biologic Agent Combination: Our Real-Life Experience With Seven Cases

Aspirin-induced respiratory disease (AERD) is a clinical condition characterized by asthma, chronic rhinosinusitis, nasal polyposis (NP), and aspirin (ASA)/non-steroidal anti-inflammatory drug intolerance. ASA desensitization combined with biological agents is considered a new treatment strategy that improves asthma control and reduces polyp recurrence in resistant cases. The aim of this study is to present the results of combination therapy with ASA desensitization and biological agents based on real-world data obtained at our center.

Seven cases followed with diagnoses of asthma, nasal polyposis (NP), and aspirin-exacerbated respiratory disease (AERD) at the Ege University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology between 2024 and 2025 were retrospectively evaluated.

The mean age of the patients was 47.00 ± 8.70 years. All seven patients were diagnosed with NP and AERD; six were receiving step-4 asthma treatment, and six had a history of surgery due to NP. Atopy was present in six cases, as confirmed by skin prick test (dpt) or specific IgE levels. The aspirin (ASA) provocation test, which started with 20 mg and escalated to 325 mg, was successfully completed by all patients. ASA treatment was initiated at a dose of 600 mg in five patients, 450 mg in one patient, and 300 mg in one patient, with the maintenance dose continued at 300 mg. To achieve asthma control and suppress symptoms of severe type 2 inflammation, biological agents were initiated in four patients before ASA treatment and in three patients after ASA treatment (Table 1). One patient developed nausea and vomiting on the 15th day of therapy; subsequent endoscopy revealed gastritis, leading to the discontinuation of ASA treatment and the initiation of mepolizumab five months later. With ASA desensitization therapy, nasal congestion resolved completely in all seven patients, and anosmia improved in five patients. Five patients who required oral corticosteroids for nasal congestion prior to therapy did not require them post-treatment. Four patients experienced no NP recurrence, while two patients had NP recurrence following surgery and current treatment but did not require reoperation. Five patients showed significant improvement in their Asthma Control Test (ACT) scores. Analysis of SNOT-22 scores at the 3rd month of ASA treatment revealed that scores improved from moderate to normal in three patients, from severe to mild in two patients, from severe to normal in one patient, and from very severe to normal in one patient. ASA and biological combination therapy is continuing safely in six patients.

ASA desensitization and biological agents are among the effective treatment options for patients with AERD. The combination of ASA desensitization and biological agents stands out as a safe and advantageous therapeutic strategy that enhances clinical efficacy in patients with refractory nasal polyposis, without leading to additional adverse effects.