Pólipos nasales, cirugía de revisión e inflamación eosinofílica: Una experiencia preliminar con Biológicos

A Preliminary Experience with Biologics

Abstract

Introduction and objective: The treatment of nasal polyposis is corticosteroids, and if they fail, surgery. However, many patients need successive surgeries, so they need better treatments Basic research on type 2 inflammatory immune response in rhinosinusal mucosa offers us the possibility of blocking the immune-mediated inflammatory reaction in the mucosa of patients with CRSwNP. We have monoclonal antibodies capable of blocking immunoglobulins Il-4 and Il-13, Il-5 and eosinophils and IgE in the nasal mucosa. Given the association between nasal polyps and type 2 inflammation in 85% of the patients, knowledge on eosinophils and biological therapies could change the management of the polyp recurrences and could avoid successive procedures or radical surgeries.Method: We reviewed a retrospective cohort of patients underwent ESS in a university tertiary hospital in the north of Spain (350,000 inhabitants), between January 1, 2016 and December 30, 2020, with more than one year follow-up. All surgical procedures were performed with the FEES technique described by Stammberger (1): healthy mucosa was respected, and all pathological sinus cavities were opened. Surgical tissue specimens were stained with haematoxylin-eoxilin and eosinophil identification was performed. Surgical revision rate was investigated. Data from our preliminary experience in biologics for patients with nasal polyps are also reported.Results: The global revision surgery rate for CRS was 18%. Eosinophil count was performed in 157 patients with nasal polyps. Out of them, 71% (n=111) had a high eosinophil count in the surgical specimens. Patients with nasal polyps and an elevated eosinophil count had a Revision Surgical Rate of 34,2% (38/111). If the eosinophils were not elevated in polyp tissue, the Revision Surgical Rate was 16,6% (8/48), with significant differences in Chi-square test (p=0,0125). The comparison of patients having a high eosinophil mucosa count revealed an OR of 3,2117 (IC95% 1,2440-8,2918). Biologic therapy is administrated in 7 patients with severe asthma poorly controlled with corticosteroids and beta agonists. Despite the short follow-up, to date we have not reoperated patient after biologics.Discussion and Conclusions: Many patients with nasal polyps need successive surgeries, so they need better treatment. It is important to consider patient- specific factors that affect revision surgery rates such as elevate eosinophil count to find better treatments. Biological therapies may change the management of the polyp recurrences and could avoid successive procedures or radical surgeries in these high risk patients.