Endotype of chronic rhinosinusitis with nasal polyps in Morocco: A cross-sectional multicentric study

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type of chronic rhinosinusitis involving persistent inflammation of the nasal and sinus cavities accompanied by polyps. New classifications define endotypes of this condition based on molecular and cellular biomarkers of inflammation. A better understanding of CRSwNP's pathophysiology has led to the development of monoclonal antibody-based biotherapies that specifically target inflammatory biomarkers involved in this pathology. With the advent of these biotherapies, endotyping has become increasingly important for optimal, personalized therapeutic strategies. While the inflammatory profile in the United States, Europe, Australia, and Japan is predominantly eosinophilic (type 2), Asian countries have a mixed profile, including a predominantly neutrophilic inflammatory response. Our goal was to determine the prevalence of the type 2 inflammatory response among Moroccan patients with CRSwNP by using blood eosinophil levels as a biomarker.

We conducted a cross-sectional prevalence study at four Moroccan hospitals, including 48 patients with CRSwNP. We defined the type 2 endotype according to the 2023 EPOS/EUFOREA criteria using blood eosinophil counts of at least 150 cells/mm³.

Among our patients, 93.8% demonstrated a type 2 endotype (95% confidence interval: 82.8% - 98.7%). The median age was 54.5 years (range, 22-73), and the male-to-female ratio was approximately 1.5:1.

The predominant endotype of CRSwNP in our population appears to be type 2. However, these results need to be confirmed by multicenter studies on a larger scale to refine therapeutic indications and better adapt management to our regional specificities.