Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis,Journal of Allergy and Clinical Immunology

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Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis
Journal of Allergy and Clinical Immunology ( IF 11.4 ) Pub Date : 2021-09-17 , DOI: 10.1016/j.jaci.2021.09.009
Paul Oykhman ₁ , Fernando Aleman Paramo ₁ , Jean Bousquet ₂ , David W Kennedy ₃ , Romina Brignardello-Petersen ₄ , Derek K Chu ₅

Affiliation

Background

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory condition of the upper airways. Optimal management is unclear.

Objective

We compared the effects of mAbs and aspirin desensitization (ASA-D) for treatment of CRSwNP.

Methods

We searched the Medline, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, US Food and Drug Administration, and the European Medicines Agency databases from inception to August 4, 2021, for randomized controlled trials comparing the effects of mAbs and ASA-D for CRSwNP. We conducted network meta-analysis of sinusitis symptoms, heath-related quality of life, rescue oral corticosteroids and surgery, endoscopic and radiologic scores, and adverse events. We used the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach to assess certainty of evidence. PROSPERO CRD42020177334.

Results

Twenty-nine randomized controlled trials evaluating 8 treatments (n = 3461) were included in the network meta-analysis. Compared to placebo, moderate to high certainty evidence showed that health-related quality of life (SNOT-22) improved with dupilumab (mean difference [MD] −19.91 [95% confidence interval (CI) −22.50, −17.32]), omalizumab (MD −16.09 [95% CI −19.88, −12.30]), mepolizumab (MD −12.89 [95% CI −16.58, −9.19], ASA-D (MD −10.61 [95% CI −14.51, −6.71]), and benralizumab (MD −7.68 [95% CI −12.09, −3.27]). The risk of rescue nasal polyp surgery likely decreased with dupilumab (risk difference [RD] −16.35% [95% CI −18.13, −13.48]), omalizumab (RD −7.40% [95% CI −11.04, −2.43]), mepolizumab (RD −12.33% [95% CI −15.56, −7.22]), and ASA-D (RD −16.00% [95% CI −19.79, 0.21]; all moderate certainty). Comparisons among agents show with moderate to high certainty that dupilumab ranks among the most beneficial for 7 of 7 outcomes, omalizumab for 2 of 7, mepolizumab for 1 of 7, and ASA-D for 1 of 7.

Conclusions

Multiple biologics and ASA-D credibly improve patient-important outcomes, with clinically important differences in effects among agents; dupilumab uniquely ranks among the most beneficial for all outcomes studied.

中文翻译：

单克隆抗体和阿司匹林脱敏治疗慢性鼻窦炎伴鼻息肉的疗效和安全性比较：系统评价和网络荟萃分析

背景

伴有鼻息肉病的慢性鼻窦炎 (CRSwNP) 是一种上呼吸道的炎症性疾病。最佳管理尚不清楚。

客观的

我们比较了单克隆抗体和阿司匹林脱敏 (ASA-D) 治疗 CRSwNP 的效果。

方法

我们检索了 Medline、Embase、Cochrane Central Register of Controlled Trials、国际临床试验注册平台、美国食品药品监督管理局和欧洲药品管理局数据库从开始到 2021 年 8 月 4 日，以获取比较 mAb 和用于 CRSwNP 的 ASA-D。我们对鼻窦炎症状、健康相关的生活质量、挽救性口服皮质类固醇和手术、内窥镜和放射学评分以及不良事件进行了网络荟萃分析。我们使用推荐评估、开发和评估等级 (GRADE) 方法来评估证据的确定性。PROSPERO CRD42020177334。

结果

网络荟萃分析纳入了 29 项评估 8 种治疗方法的随机对照试验（n = 3461）。与安慰剂相比，中等至高确定性证据表明，使用 dupilumab（平均差 [MD] -19.91 [95% 置信区间 (CI) -22.50, -17.32]），奥马珠单抗改善了健康相关的生活质量 (SNOT-22) (MD -16.09 [95% CI -19.88, -12.30])，美泊利单抗 (MD -12.89 [95% CI -16.58, -9.19], ASA-D (MD -10.61 [95% CI -14.51, -6.71])和贝那利珠单抗（MD -7.68 [95% CI -12.09, -3.27]）。dupilumab 可能降低挽救性鼻息肉手术的风险（风险差异 [RD] -16.35% [95% CI -18.13, -13.48]）、奥马珠单抗 (RD -7.40% [95% CI -11.04, -2.43])、美泊利单抗 (RD -12.33% [95% CI -15.56, -7.22]) 和 ASA-D (RD -16.00% [95% CI] −19.79, 0.21]；所有中等确定性）。