1. High Discontinuation Rates of Peroral ASA Treatment for CRSwNP: A Real-World Multicenter Study of 171 N-ERD Patients
- Author
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Seija Vento, Sanna Toppila-Salmi, Heikki Turpeinen, Jura Numminen, Johanna Sahlman, Paula Virkkula, Paula Kauppi, Anu Laulajainen-Hongisto, Maija Hytönen, HUS Head and Neck Center, Korva-, nenä- ja kurkkutautien klinikka, Clinicum, Department of Dermatology, Allergology and Venereology, University of Helsinki, HUS Inflammation Center, Helsinki University Hospital Area, Department of Pathology, and Medicum
- Subjects
medicine.medical_specialty ,Chronic rhinosinusitis with nasal polyposis ,medicine.drug_class ,CHRONIC RHINOSINUSITIS ,03 medical and health sciences ,Nasal Polyps ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Eosinophilia ,ASPIRIN DESENSITIZATION-TREATMENT ,Nasal polyps ,030212 general & internal medicine ,Sinusitis ,RECURRENCE ,Aspirin desensitization ,Retrospective Studies ,Rhinitis ,Asthma ,OUTCOMES ,Aspirin ,Aspirin treatment after desensitization ,EXACERBATED RESPIRATORY-DISEASE ,business.industry ,Respiratory disease ,Hazard ratio ,Nonsteroidal anti-inflammatory drug exacerbated respiratory disease ,medicine.disease ,PREVALENCE ,3. Good health ,Discontinuation ,LIFE ,030228 respiratory system ,3121 General medicine, internal medicine and other clinical medicine ,Chronic Disease ,Corticosteroid ,medicine.symptom ,Airway ,business ,ENDOSCOPIC SINUS SURGERY - Abstract
BACKGROUND: Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) consists of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and NSAID intolerance. Acetylsalicylic acid treatment after desensitization (ATAD) is a treatment option for uncontrolled N-ERD. OBJECTIVE: To evaluate peroral ATAD's long-term effectiveness on CRSwNP disease control. METHODS: The retrospective data (patient characteristics, sinus surgeries before ATAD, ATAD, follow-up data [20191) were collected from patient records of 171 patients with N-ERD (102 ATAD patients, 69 controls with CRSwNP-F N-ERD without ATAD) who underwent tertiary hospital consultation from 2001 to 2017. Outcome measurements were ATAD discontinuation, revision sinus surgery, and corticosteroid and antibiotic courses for airway infections during 2016-2019. Associations were analyzed by survival and nonparametric methods. RESULTS: The ATAD group had more tissue eosinophilia, symptoms, and sinus surgeries before ATAD than others. The ATAD discontinuation rate was 63%, independent of ATAD dose or duration, usually due to side effects. Compared with the N-ERD group without ATAD, ATAD (mean duration, 2.9 years) did not affect the revision endoscopic sinus surgery rate (P = .21, by the log-rank test) or the number of peroral corticosteroid courses per year (P > .05, by the Mann-Whitney U-test) during the follow-up (mean, 7.6 years) despite the dose or duration of ATAD. CONCLUSIONS: The discontinuation rate of ATAD was high (63%), and ATAD did not affect revision sinus surgery rate nor the need of peroral corticosteroids during follow-up. However, the remaining 37% of the ATAD group did continue the treatment, indicating that they may have benefited from ATAD. (C) 2020 American Academy of Allergy, Asthma & Immunology
- Published
- 2020
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