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Biologic Therapy and Aspirin Reactivity in AERD: A Scoping Review
Natalie Albasha1, Andrew A White2
1Division of Internal Medicine, Scripps Clinic, San Diego, CA.
Summary
Biologic therapies show limited but promising effects on aspirin reactivity in Aspirin-Exacerbated Respiratory Disease (AERD). Further research is crucial to understand their impact on cyclo-oxygenase 1 (COX-1) reactivity for better patient management.
Area of Science:
- Immunology
- Pharmacology
- Respiratory Medicine
Background:
- Aspirin-Exacerbated Respiratory Disease (AERD) involves respiratory reactions to cyclo-oxygenase 1 (COX-1) inhibitors.
- This reactivity often persists despite inflammation control.
- Biologic agents targeting type 2 inflammation are increasingly used in AERD management.
Purpose of the Study:
- To systematically review the impact of biologic therapies on aspirin/COX-1 reactivity in AERD patients.
Main Methods:
- A comprehensive literature search identified studies on omalizumab, dupilumab, mepolizumab, benralizumab, reslizumab, and tezepelumab.
- Evaluation focused on their effects on aspirin reactivity in AERD.
Main Results:
- 23 studies were selected from 652 initial articles.
- Omalizumab and dupilumab showed the most frequent improvements in aspirin challenge thresholds.
- Evidence for other biologics was minimal; studies were small and often uncontrolled.
Conclusions:
- Limited, small, and non-randomized studies exist on biologics' effects on COX-1 reactivity in AERD.
- Larger, controlled studies are needed to precisely measure therapy effects on aspirin reactivity.
- Predictive methods for resolving aspirin reactivity are necessary for patient counseling.
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