Sebastian Kotz (München), Zhaojun Zhu (München), Claudia Jerin (München), Evamaria Stütz (München), Constanze Jakwerth (München), Barbara Wollenberg (München), Carsten Schmidt-Weber (München), Adam Chaker (München)
Introduction
Type-2 biologics allow for successful treatment of patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). Eosinophils have been established as a reliable biomarker of type-2 disease and enable the differentiation of inflammatory patterns in CRSwNP. Aim of this study was to evaluate, whether peripheral blood eosinophilia before initiation of therapy with type-2 biologics allows assesment of response to treatment in patients with CRSwNP.
Methods
We analyzed 55 patients with CRSwNP who were treated with type-2 biologics in our ENT-clinics for at least 12 months. The following parameters were assesed in all subjects before first treatment was administered: serum IgE, differential blood count, nasal polyp score (NPS) and SNOT-22. After 12 months, response to treamtent was evaluated using clinical parameters NPS and SNOT-22. Patients with hypereosinophilia underwent further evaluation.
Results
At 12 months, there was a low-to-moderate correlation of baseline eosinophils with reduction of NPS (ΔNPS%, r=0.27, p<0.05). Also improved results of SNOT-22 (ΔSNOT%) trended to a weak-to-moderate correlation with baseline eosinophils (r=0.23, p=0.09). There was no correlation between IgE and clinical response to treatment as evindenced by reduction of NPS (ΔNPS%) or SNOT-22 (ΔSNOT%). There was no correlaton between serum IgE and baseline eosinophils.
Discussion
These results need to be interpreted with caution as they refer to all currently licensed type-2 biologics. As useful as blood-eosinophils and serum IgE may be to assess overall type-2 inflammation in a patient, these values do not necessarily represent the situation in the inflamed tissue. A diagnostic utility for therapy prediction was not shown in this sample and is considered unlikely.
Dr. Kotz reports speaker honoraria and other from Takeda and GSK via TUM.
Dr. Chaker reports grants, speaker honoraria, consultancy or advisory fees and/or research support and other all via Technical University of Munich from Allergopharma, ALK Abello, Astra Zeneca, Bencard/Allergen Therapeutics, GSK, Hippo Dx, Novartis, LETI, Roche, Zeller, Sanofi Genzyme/Regeneron, Thermo Fisher, European Institute of Technology (EIT Health) and Federal Ministery of Research and Education Germany.