The clinical course of chronic rhinosinusitis with sinonasal polyposis in patients with eosinophilic asthma amid the treatment

Background: chronic rhinosinusitis (CRS) with polyps is associated with eosinophilic inflammation where interleukin-5 (IL-5) is acting as a key mediator. Commonly, CRS co-exists with asthma. Aim: to assess the efficacy of reslizumab for the treatment of CRS with sinonasal polyposis in patients with severe eosinophilic asthma. Patients and Methods: the study included 21 patients. For the management of severe asthma all patients received reslizumab as intravenous infusion at a dose of 3 mg/kg body weight, once every 4 weeks. CRS with sinonasal polyposis was found in 19 patients, pathological changes of the paranasal sinuses revealed by computer tomography (CT) — in all patients, and symptoms of chronic non-allergic rhinitis with eosinophilia syndrome (NARES) were present in 2 patients. The efficacy of therapy was evaluated 6 months after the beginning of treatment. Over-time changes in the following indicators were evaluated: nasal symptoms, endoscopic pattern of the nasal cavity and paranasal sinuses, total polyp score (TPS), CT findings in the paranasal sinuses, rhinocytogram, blood eosinophil cationic protein level, and eosinophilia. The effectiveness of asthma control was assessed by the reduction in asthma exacerbation rate and the requirements for systemic corticosteroids, as well as the spirometry results and the asthma control test. Results: along with a noticeable improvement of asthma control, 20 patients had clinical, endoscopic and radiological signs of the decrease in severity of nasal symptoms. A more significant improvement of asthma control was achieved in patients with CRS and polyps. The medical histories of patients with CRS and polyps demonstrated that at the early stages of the disease they had NARES symptoms. This finding suggests that NARES could be a predictor of eosinophilic non-IgE-mediated asthma and nasal polyps. Conclusion: the use of reslizumab for the treatment patients with eosinophilic asthma and comorbid CRS with polyps and NARES enables not only to improve the control of asthma symptoms but also to achieve the notable regression of nasal symptoms. KEYWORDS: chronic rhinosinusitis with polyps, asthma, iterleukin-5, reslizumab, non-allergic rhinitis with eosinophilia syndrome. FOR CITATION: Boyko N.V., Churyukina E.V., Lodochkina O.E., Ukhanova O.P. The clinical course of chronic rhinosinusitis with sinonasal polyposis in patients with eosinophilic asthma amid the treatment. Russian Medical Inquiry. 2023;7(2):103–109 (in Russ.). DOI: 10.32364/2587-6821-2023-7-2-103-109.