Assistant Professor Mayo Clinic Arizona Mayo Clinic Arizona
Objective: To compare treatment outcomes between endoscopic sinus surgery(ESS) and biologics for severe chronic rhinosinusitis with nasal polyposis(CRSwNP).
Study design: Outcomes from a prospective, multicenter cohort of CRSwNP patients undergoing ESS between 2011-2019 were compared to Phase-3 biologic trial data.
Methods: Patients meeting inclusion criteria modified from recent dupilumab-LIBERTY-NP, omalizumab-POLYP, and mepolizumab-SYNAPSE trials were included in this study. Baseline patient characteristics and outcomes were compared between the ESS cohort and the aforementioned biologic trials at 24-weeks and 52-weeks.
Results: One-hundred eleven CRSwNP patients met modified inclusion criteria. Baseline characteristics of ESS and biologic groups were statistically similar. At 24-weeks, ESS demonstrated significantly greater improvements in SNOT-22 scores compared to one(of two) dupilumab trials(p < 0.05) and both omalizumab trials (p < 0.01). ESS resulted in significantly lower nasal polyp scores(NPS) compared to dupilumab(p < 0.01) and omalizumab(p < 0.001), despite comparable improvements in psychophysical olfaction(p>0.05). At 52-weeks, ESS resulted in comparable improvements in SNOT-22 scores compared to dupilumab(p=0.21), but NPS remained significantly lower in the ESS group compared to dupilumab(p < 0.01) and mepolizumab(p < 0.01).
Conclusions: At 24 weeks, ESS offers equivalent-to-superior SNOT-22 improvements compared to dupilumab, but these differences diminish at 52 weeks. ESS and dupilumab offer comparable improvements in psychophysical olfaction. Compared to omalizumab, ESS offers superior SNOT-22 improvements. ESS offers significantly greater reductions in polyp size compared to omalizumab, dupilumab, and mepolizumab.