Association Between Biologic Therapy and Reduced Acute Rhinosinusitis Episodes: A Retrospective Database Study

Area of Science:

• Immunology
• Respiratory Medicine
• Pharmacology

Background:

• Biologics are increasingly used for various inflammatory conditions.
• The impact of biologics on sinonasal health, particularly acute bacterial rhinosinusitis (ABRS), is not fully understood in non-CRSwNP populations.
• Understanding potential off-target benefits of biologics is crucial for comprehensive patient care.

Purpose of the Study:

• To investigate if biologics (dupilumab, mepolizumab, omalizumab) reduce ABRS episodes in patients without chronic rhinosinusitis with nasal polyps (CRSwNP).
• To evaluate the comparative effectiveness of different biologics in preventing ABRS in this specific patient group.

Main Methods:

• Retrospective cohort study using the All of Us Research Program database.
• Identified patients treated with dupilumab, mepolizumab, or omalizumab, excluding those with CRSwNP.
• Propensity score matching (1:1) and K-nearest neighbors were used to create a control group matched for demographics and comorbidities.
• Primary outcome: frequency of ABRS episodes, analyzed using chi-squared tests to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

• A total of 2094 subjects were analyzed.
• The biologic group showed a significantly lower ABRS rate (6%) compared to controls (14%) (OR 0.4349, p < 0.0001).
• Dupilumab demonstrated the most significant reduction in ABRS risk (OR 0.1526, p < 0.001044).
• Mepolizumab and omalizumab showed a trend towards decreased ABRS episodes, but results were not statistically significant.

Conclusions:

• Dupilumab significantly reduces ABRS episodes in patients without CRSwNP, indicating a potential protective effect on sinonasal health.
• These findings suggest biologics may offer benefits beyond their primary indications.
• Further research is warranted to confirm these effects and assess long-term safety in non-CRSwNP populations.