Current Goals of NSAID-ERD Management: Patient-Centered Approaches Involving NSAID Desensitization With and Without...

Area of Science:

• Immunology
• Respiratory Medicine
• Pharmacology

Background:

• Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) traditionally managed with NSAID avoidance, medications, and surgery.
• Severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) are often type 2, eosinophilic diseases.
• Biologics targeting type 2 inflammation offer new therapeutic avenues.

Purpose of the Study:

• To review the role of aspirin therapy after desensitization (ATAD) in NSAID-ERD.
• To compare biologic therapies with ATAD for NSAID-ERD.
• To discuss considerations for ATAD even with available type 2 biologics.

Main Methods:

• Review of existing literature on NSAID-ERD treatments.
• Analysis of clinical outcomes for biologics (e.g., dupilumab, omalizumab) in NSAID-ERD.
• Comparison of patient preferences for biologics versus ATAD.

Main Results:

• Biologics targeting IgE, IL-5, IL-4, and IL-13 are effective for severe asthma and CRSwNP in NSAID-ERD.
• Dupilumab shows greater efficacy in NSAID-ERD patients compared to aspirin-tolerant individuals.
• Omalizumab rapidly reduces inflammatory mediators and may restore aspirin tolerance in some patients.

Conclusions:

• Biologics represent a significant alternative to ATAD, often favored by patients.
• ATAD remains a consideration, particularly when complete NSAID tolerance restoration is a goal.
• Patient-centered care should guide treatment decisions, weighing biologic efficacy against ATAD benefits.