Evaluation of the improvement of quality of life with Azithromycin in the treatment of eosinophilic nasal polyposis (original) (raw)
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Azithromycin for the treatment of eosinophilic nasal polyposis: Clinical and histologic analysis
Allergy & rhinology (Providence, R.I.), 2016
Macrolides used as immunomodulators are a promising tool for chronic inflammatory airway diseases. Eosinophilic nasal polyposis (ENP) is still considered a disease that is difficult to control with the currently standardized treatments. To evaluate prolonged treatment with low-dose azithromycin for ENP based on clinical and histopathologic variables. The present investigation was a self-paired case study of 33 patients with ENP. A comparison was performed between patients before and after treatment with azithromycin for 8 weeks. The patients were subjected to clinical examinations, staging (three-dimensional imaging by endoscopy), application of the questionnaire, and biopsy of nasal polyps at the beginning and at the end of the treatment. The treatment yielded a clinical improvement regarding the two variables studied: polyposis staging (69.7%) and questionnaire (57.6%). We did not find significant differences in the inflammatory pattern and in the percentage or absolute number of ...
Journal of Medical Biochemistry, 2000
Immunomodulatory treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) by macrolide antibiotics represents a challenging alternative to conventional therapy and surgery, still being at the very beginning. Immune and inflammatory processes in nasal and paranasal sinus mucosa, crucial in the etiopathogenesis of nasal polyps (NPs) are reflected in levels of various local mediators, found both in mucosa and nasal fluid. In this prospective study, we assessed the immunomodulatory and clinical effects of longterm low-dose oral macrolide treatment in the management of CRSwNP. Twenty-two (n = 22) nonasthmatic, nonallergic patients with CRSwNP were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory cytokines TNF-a, TNF-b, and IL-1b, Th1 cytokines IL-2, IL-12, and IFN-g, Th2 cytokines IL-4, IL-5, IL-6, and IL-10, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using a flow cytometric method. We also scored each of the 22 patients before and after therapy according to Tsicopoulos' global nasal symptom score and Malm's endoscopic score. Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-a (p<0.01) in nasal secretions. Macrolide therapy decreased the size of polyps in 45.45% of the patients. We concluded that long-term low-dose treatment with CAM was effective in the management of Kratak sadr`aj: Mada je u samim za~e cima, imunomo dulacijska terapija hroni~nog rinosinuzitisa sa nosnom poli pozom (HRSsNP) primenom makrolidnih anti biotika bi mogla predstavljati alternativu uobi~ajenoj konzer va tivnoj terapiji, kao i hirur{kom le~enju. Imunski i zapaljen ski procesi u sluzoko`i nosa i paranazalnih sinusa, naj zna ~ajniji u etiopato genezi nosnih polipa, reflektuju se na razli~ite lokalne medijatore, detektovane u sluzoko`i kao i u nosnom sekretu. U ovoj prospektivnoj studiji procenili smo imunomo dulacijske i klini~ke efekte dugotrajne niskodozirane oralne primene makrolidnog antibiotika u le~enju HRSsNP. Dva deset dvoje (n = 22) neastmati~nih, nealergi~nih pacijenata sa HRSsNP dobijalo je klaritromicin (CAM) u pojedina~noj dnevnoj dozi od 500 mg tokom osam nedelja. Merene su koncentracije proinflamatornih citokina TNF-a, TNF-b i IL-1b, Th1-cito kina IL-2, IL-12 i IFN-g, Th-2-citokina IL-4, IL-5, IL-6 i IL-10, kao i hemokina IL-8 u uzorcima nosnog sekreta, pre i nakon tera pije, primenom proto~ne citometrije. Svaki od pacijenata klini~ki je klasif i kovan pre i posle le~enja prema Tsicopoulosovom ukupnom nosnom simptom skoru i Malm-ovom endoskopskom skoru. Nakon le~enja, detektovane su znaajno ni`e koncentracije IL-8 (p<0,01) i TNF-a (p<0,01) u nosnom sekretu. Terapija makrolidnim antibio tikom je smanjila veli~inu polipa kod 45,45% od ukupnog bro ja paci jenata. Zaklju~eno je da je dugotrajna nisko dozirana primena
2018
OBJECTIVE To assess the quality of life (QoL) and recurrence of disease in patients with eosinophilic (ECRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyposis (non-ECRSwNP) post endoscopic sinus surgery (ESS). METHODOLOGY A cross-sectional comparative study was carried out in the Otorhinolaryngology - HNS Department, Universiti Kebangsaan Malaysia Medical Center (UKMMC). Subjective assessments of nasal symptoms and quality of life (QoL) using SNOT-22 and Visual Analogue Scale (VAS) and objective endoscopic assessment was undertaken using a modified Hadley endoscopic examination. RESULTS There was no significant statistical difference in the quality of life between the ECRSwNP and non-ECRSwNP groups as evidenced by the SNOT-22 score and the VAS comparison (p>0.05). However, there was a significant difference in terms of recurrence of disease with the presence of nasal polyps on endoscopic examination. (p = 0.016) CONCLUSION: In conclusion, we found that there is ...
Allergy, 2011
Chronic rhinosinusitis (CRS) is defined in the European Position Paper on rhinosinusitis and nasal polyps (EP 3 OS) as the presence of two or more symptoms of which one should be either nasal blockage/congestion or nasal discharge combined with facial pain/pressure and/or reduction/loss of smell for more than 12 weeks (1). This definition is completed with accompanying nasal endoscopic signs and/or corresponding mucosal changes on CT scan. In the last decades, the management of CRS has improved substantially. According to the EP 3 OS-management-schemes, patients with CRS are primarily treated with nasal saline irrigation, intranasal corticosteroids and in more severe cases with antibiotics and/or systemic corticosteroids, especially when nasal polyps are prominent. In patients who do not optimally respond to this Abstract Background: In persistent chronic rhinosinusitis (CRS), conventional treatment is often insufficient. Long-term, low-dose administration of macrolides has been suggested as a treatment option. The MACS (Macrolides in chronic rhinosinusitis) study is a randomized placebo-controlled trial evaluating the efficacy of azithromycin (AZM) in CRS. Methods: We describe a group of patients with recalcitrant CRS with and without nasal polyps unresponsive to optimal medical and (in 92% also) surgical treatment. Patients were treated with AZM or placebo. AZM was given for 3 days at 500 mg during the first week, followed by 500 mg per week for the next 11 weeks. Patients were monitored until 3 months post-therapy. The assessments included Sino-Nasal Outcome Test-22 (SNOT-22), a Patient Response Rating Scale, Visual Analogue Scale (VAS), Short Form-36 (SF-36), rigid nasal endoscopy, peak nasal inspiratory flow (PNIF), Sniffin' Sticks smell tests and endoscopically guided middle meatus cultures. Results: Sixty patients with a median age of 49 years were included. Fifty per cent had asthma and 58% had undergone revision sinus surgery. In the SNOT-22, Patient Response Rating Scale, VAS scores and SF-36, no significant difference between the AZM and the placebo groups was demonstrated. Nasal endoscopic findings, PNIF results, smell tests and microbiology showed no relevant significant differences between the groups either. Conclusion: At the investigated dose of AZM over 3 months, no significant benefit was found over placebo. Possible reasons could be disease severity in the investigated group, under-dosage of AZM and under-powering of the study. Therefore, more research is urgently required.
Chronic rhinosinusitis with nasal polyposis: the role of personalized and integrated medicine
Monaldi Archives for Chest Disease, 2021
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common disorder. From a clinical and immunopathological point of view, different phenotypes and endotypes have been identified. As asthma is frequent comorbidity, biological agents for treating CRSwNP associated with asthma may be an attractive strategy. Biological agents have several mechanisms, such as antagonizing IgE, interleukin (IL) 4, IL-5, and IL-13. However, a workup is mandatory, mainly concerning pheno-endotyping. In this regard, clinical cytological grading (CCG) has been proposed as a useful tool to manage patients with CRSwNP as it allows us to define clinical and immunopathological phenotypes able to identify the ideal candidate for biologics. In particular, the mixed cellular pattern, such as eosinophils and mast cells, could be sensitive to anti-IL-4 agents. There is still a need for well-established indications, criteria of responsiveness, duration, and safety. Moreover, personalized medicine could be opport...
Biomedical Papers, 2010
Aims. Cytokine levels in nasal secretions reflect the inflammatory status of the nasal and paranasal sinus mucosa and the development of mucosal disease. The results of previous investigations suggest that macrolide antibiotics can be effective in treatment of chronic rhinosinusitis and nasal polyposis. The aim of this prospective study was to compare the immunomodulatory and clinical effects of long-term low-dose macrolide treatment of nonatopic and atopic patients with nasal polyposis. Methods. Forty (n = 40) patients with nasal polyposis, 22 allergic and 18 nonallergic were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory Th1 cytokines TNF-α and IL-1β, Th2 cytokines IL-4, IL-5 and IL-6, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using flow cytometric method. We also scored each of the 40 patients before and after therapy according to nasal symptom score and endoscopic score. Results. Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-α (p<0.01) in nasal secretions in nonallergic patients. In subjects with nasal polyposis and allergy, we found decreased levels of IL-8 (p<0.01), IL-6 (p<0.05) and IL-1β (p<0.01). Macrolide therapy decreased the size of polyps in 45.45% of nonatopic and in 50% of atopic patients. After macrolide treatment, we found 67.83% patients in nonallergic group and 55.55% patients in allergic group with improved nasal symptoms. Conclusions. Long-term low-dose treatment with CAM was effective in the management of nasal polyposis. Our results showed that macrolide treatment of nasal polyposis have different immunomodulatory and similar clinical effects in allergic and nonallergic patients. tegrated process of mucosal epithelium, lamina propria and inflammatory cells, which, in turn, may be initiated by both infectious and noninfectious inflammation 1. Nasal polyposis is an example of an extreme immune dysregulation 2. The mechanisms responsible for selective accumulation of eosinophils and neutrophils in polyps are unknown. Nasal polyp fibroblasts could play a role in the recruitment of eosinophils and neutrophils through the release of RANTES (regulated on activation, normal T cell expressed and secreted) and GM-CSF (granulocytemacrophage colony-stimulating factor) 3. Several cytokines (interleukin (IL)-4, IL-5, IL-6, IL-8, tumor necrosis factoralpha (TNF-α), RANTES, GM-CSF) have been shown to be upregulated in nasal polyposis, suggesting that resident structural cells can produce a number of molecules to attract inflammatory cells and prolong their survival. These inflammatory cells themselves can also produce cytokines which recruit more inflammatory cells in an autocrine fashion 3. Although surgery has been the preferred treatment for nasal polyposis for a long time, a change in the treatment strategy in recent years has lead to greater use of medica-ABBREVIATIONS IL-Interleukin TNF-Tumor necrosis factor
Predictive factors for identifying macrolide responder in treating chronic rhinosinusitis
Rhinology journal, 2021
BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders. METHODOLOGY: A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤5, and no rescue medication. RESULTS: One hundred CRS patients (mean age 47.4±14.1 years, 45% male) were enrolled. Univariable logistic regression showed loca...
Allergy & Rhinology, 2016
Background The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) involves both surgical and medical approaches, and remains a controversial subject. Objective The objective of this prospective, randomized, controlled trial was to compare the medical and surgical treatments of CRSwNP in terms of their effect on the nasal congestion index (NCI). Methods Forty-eight patients with CRSwNP were randomized either to medical or surgical therapy. Pretreatment and 3-and 6-month posttreatment assessments of the visual analog scale score, the 20-Item Sino-Nasal Outcome Test, saccharine clearance time, nasal endoscopy, and NCI measurement with acoustic rhinometry were performed. Forty-one subjects were included in the analysis. Results Both the medical and surgical interventions for CRSwNP resulted in significant improvement in the visual analog scale score, 20-Item Sino-Nasal Outcome Test, saccharine clearance time, and nasal endoscopic examination scores. There was no differen...
The value of a Feasibility Study into long-term Macrolide therapy in Chronic Rhinosinusitis
Clinical Otolaryngology, 2016
There is currently conflicting level 1 evidence in the use of long-term antibiotics for chronic rhinosinusitis without nasal polyps. The primary aim of this feasibility study was to optimise future randomised trial design by assessing recruitment and retention of patients alongside providing preliminary data on symptomatic control. Design Prospective, multi-centre feasibility (cohort) study with all patients receiving macrolide therapy for 12-weeks and a further subsequent 12-week follow-up. Participants received a 12-week course of Clarithromycin 250mg alongside twice daily topical Mometasone and nasal douching. Primary outcomes focused on recruitment, retention and compliance. Clinical and quality-of-life outcomes measures were also recorded. Setting Patients were prospectively recruited from 6 UK outpatient clinics.
Comparison of Oral Steroids, Macrolides and Combination Therapy in Nasal Polyposis Patients
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2018
N asal polyps (NP) are benign and are characterised by mucosal inflammation and expansion into the lumen of the nasal cavity. They are typically pale grey protrusions and are induced by multifactorial causes. The prevalence in the general population ranges between 1 and 4%, and they mostly affect adult individuals. [1] These polyps have been known since ancient times, and yet the pathogenesis and treatment of NP remain to be fully elucidated. In recent years, NP has been considered to represent a subgroup of chronic sinusitis. [2] The most important factors in the development of nasal polyps are viewed as chronic inflammation and mucosal oedema. Other factors that may play a Objectives: In this study, our aim was to compare oral steroid therapy with macrolide therapy and with oral steroid + macrolide (combine) therapy in patients with nasal polyposis (NP). Methods: All patients were treated with nasal steroid therapy for eight weeks and divided randomly into three groups as follows: Oral steroid group, oral macrolide group and combine group. All patients underwent endoscopic staging, radiological grading, odour testing and completed the sino-nasal outcome test-22 (SNOT-22) questionnaire before and after treatment. Results: Significant improvement was observed in all parameters after treatment in all three groups. All parameters were significantly better in the combined group than in the macrolide group. Comparison of the oral steroid group and macrolide group revealed significantly better radiological grading and odour test changes for the oral steroid group, but no statistically significant differences existed according to endoscopic staging and SNOT-22. The post-treatment SNOT-22 score was significantly better in the combined group than in the steroid group. A comparison of the combined and steroid groups showed better results for the combined group for all parameters, but the differences were not significant. Conclusion: All treatment protocols were effective and the successful use of macrolide indicates its potential as an alternative in patients with contraindications to oral steroid treatment. The combined treatment may demonstrate significantly better results than steroid treatment alone if larger studies with more patients are performed.