D3.365 - The role of anosmia in predicting biologic responsiveness for Chronic Rhinosinusitis with Nasal Polyposis

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a chronic inflammatory condition of nasal and sinus mucosa characterized by presence of benign polyps. Traditional management for  CRSwNP usually ends with surgical intervention if initial medical therapy fail. Biologics are a targeted alternative that effectively manage the inflammatory processes in CRSwNP.

In the landscape of increased use of biologics, it is important to discern better ways to find suitable CRSwNP patients. Anosmia is a hallmark symptom associated with CRSwNP; we aim to assess efficacy of biologics in relapsed CRSwNP patients and investigate whether smell tests are a good predictor tool for selecting biologic-responsive patients.

59 patients with relapsed CRSwNP (≥1 previous FESS/unresponsive to medical treatment) were referred to a combined Allergist-Otolaryngologist clinic in Queen Mary Hospital. Characteristics of this cohort was assessed i.e. features of T2 disease, rate of early relapse and surgery, and fulfilment of EPOS23 criteria.

Suitable patients were offered to start either Mepolizumab or Dupilumab. Those on at least 6 months of biologics were analysed. Outcomes were assessed by the Asthma Control Test, Sinonasal outcome test (SNOT22), Nasal polyp score, and TIB smell identification test (TIBSIT); recorded at baseline, 2, 4 and 6 months.

Of 59 patients, mean age of 1st surgery was 50.8 years, bilateral NPS score was 3.7, 59% had concomitant T2 diseases, and concomitant NSAID allergy was found in 19%.

27 patients agreed with further assessment and categorised (20 anosmic vs 7 non-anosmic). The average baseline TIBSIT in the anosmic and non-anosmic group was 1.5 vs 29.1 (p<0.001). Mean NPS (4.54 vs 2.26, p=0.036), mean no. of surgeries (1.80 vs 1.17, p=0.039), and if EPOS23 criteria was met (16 vs 0, p<0.001), were significantly different between anosmic and non-anosmic, respectively.

16 patients were given Dupilumab, 5 were given Mepolizumab for at least 6 months. The average overall improvement of the NPS was 1.875, ACT improved by an average of 38.7% and SNOT22 by an average of 39.6%.

Both biologics reduced polyp size and improved smell and comorbid asthma control in CRSwNP patients, showing their effectiveness as a less invasive treatment option. Smell tests can provide good predictions for response to biologics and should be incorporated in real life practices for Otolaryngologists and Allergists on treatment options for relapsed CRSwNP.