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Biologics and Selected Upper- and Lower-Airway Outcomes in AERD Subgroups: A Systematic Review and Meta-Analysis
Zusheng Du1, Wei Liu2, Yang Zheng1
1Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Zhifu District, Yantai, China; Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China; Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China; Shandong Engineering Research Center for Precision Diagnosis and Treatment of Airway Diseases, Yantai, China.
Background:
Aspirin-exacerbated respiratory disease (AERD) is a refractory type 2 inflammatory disorder affecting the unified airway. Conventional treatments offer limited efficacy with high recurrence. Biologics are approved for chronic rhinosinusitis with nasal polyps or asthma, but AERD-specific randomized controlled trials remain critically scarce, and quantitative synthesis of biologic efficacy specifically in AERD subgroups is limited.
Objective:
To evaluate the efficacy of biologics on selected upper- and lower-airway outcomes in AERD subgroups.
Methods:
We searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials of biologics in AERD. Upper- airway outcomes included the Nasal Polyp Score, Nasal Congestion Score, 22-item Sino-Nasal Outcome Test, and University of Pennsylvania Smell Identification Test. Lower airway outcomes included the 5-item Asthma Control Questionnaire and FEV1.
Results:
Eleven studies (15 randomized controlled trials, 818 patients with AERD) were included. Biologics significantly improved upper-airway outcomes when compared with placebo: Nasal Polyp Score (mean difference [MD], -1.33 [95% CI, -2.07 to -0.59]), Nasal Congestion Score (MD, -0.84 [95% CI, -1.15 to -0.53]), 22-item Sino-Nasal Outcome Test (MD, -19.16 [95% CI, -25.62 to -12.69]), and University of Pennsylvania Smell Identification Test (MD, 8.00 [95% CI, 1.33 to 14.66]). Lower-airway outcomes were also significantly improved: 5-item Asthma Control Questionnaire (MD, -0.90 [95% CI, -1.32 to -0.48]) and FEV1 (MD, 0.29 L [95% CI, 0.21 to 0.37]). All improvements exceeded the respective minimal clinically important difference thresholds.
Conclusions:
In AERD subgroups, biologics produced statistically significant and clinically meaningful improvements across all evaluated upper- and lower-airway outcomes, with pooled effect sizes exceeding respective minimal clinically important difference thresholds.
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