D3.97 - Postoperative Anti-IgE Therapy for Chronic Rhinosinusitis with Nasal Polyps and Asthma: Efficacy and Prognostic Factors

Omalizumab has been proven effective in treating chronic rhinosinusitis (CRS) with nasal polyps and comorbid asthma (NPwAS) patients before surgery. However, real-world studies on its postoperative use are limited. This study aimed to evaluate the effectiveness and safety of omalizumab in controlling NPwAS in patients who underwent endoscopic sinus surgery (ESS), as well as to identify predictors for the drug's efficacy.

This prospective observational study enrolled 60 NPwAS patients who underwent ESS between January 2020 and March 2023. They were divided into two groups: Control group (routine medication: nasal saline lavage and budesonide nasal spray) and Omalizumab group (omalizumab combined with routine medication). Total nasal symptom score (TNSS), visual analogue scale (VAS) of individual symptom, asthma control test (ACT) and Sino-Nasal Outcome Test-22 (SNOT-22) were evaluated by questionnaires at baseline and at month 6, while blood and nasal polyp tissue specimens were collected to explore potential predictors. CRS disease control was rated as controlled, partly controlled and uncontrolled by the standard of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS).

30 patients in the Omalizumab group and 28 in the Control group completed the treatment and follow-up. At month 6, CRS control was significantly better in the Omalizumab group compared to the Control group, with response rates of 40% and 14.3%, respectively (p = 0.009). The Omalizumab group also led to greater mean changes from baseline at month 6 in TNSS, loss of smell score, and SNOT-22 score compared to the Control group. The study demonstrated good safety profiles.

Omalizumab significantly improved NPwAS outcomes six months after surgery, highlighting its potential as an effective adjunctive therapy in the postoperative management of NPwAS.