Predictive factors for identifying macrolide responder in treating chronic rhinosinusitis

Area of Science:

• Immunology
• Otolaryngology
• Pharmacology

Background:

• Low-dose macrolides (LDM) possess anti-inflammatory and antineutrophilic properties.
• Patient selection for LDM therapy in chronic rhinosinusitis (CRS) remains a clinical challenge.
• Identifying predictors of LDM response is crucial for optimizing treatment outcomes.

Purpose of the Study:

• To identify factors predicting response to low-dose macrolide (LDM) therapy in patients with chronic rhinosinusitis (CRS).
• To evaluate the association of various clinical and immunological markers with LDM treatment outcomes.

Main Methods:

• A prospective cohort study involving 100 CRS patients treated with roxithromycin (150 mg daily for 12 weeks).
• Assessment of nine potential predictors including local and serum IgE, IL-5, eosinophils, neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity.
• Statistical analysis using receiver-operating curve and multivariable logistic regression to determine predictive factors.

Main Results:

• Low local total IgE (< 5.21) and low serum eosinophils (< 2.2%) were associated with macrolide response in univariable analysis.
• Multivariate analysis confirmed local total IgE as an independent predictor of LDM response, with 63% discriminative ability.
• Serum total IgE, nasal secretion IL-5, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity did not predict LDM response.

Conclusions:

• Low total IgE levels in nasal secretions, but not in serum, predict a positive response to low-dose macrolide therapy in CRS patients.
• This finding can aid in selecting appropriate candidates for LDM treatment, potentially improving therapeutic efficacy.