Smell improvement in chronic rhinosinusitis with nasal polyps with monoclonal antibodies: a systematic review.

Smell impairment is more commonly related to chronic rhinosinusitis with nasal polyps (CRSwNP) than without, especially given associated asthma and/or NSAID-exacerbated respiratory disease and type 2 inflammation. Therapeutic options include intranasal and systemic corticosteroids, surgery and, more recently, biological therapy. We summarize current knowledge on the effect of biologics on olfaction in patients with CRSwNP. We performed a systematic search of the PubMed and Cochrane databases from January 2001 to June 2022. Inclusion criteria were: adult patients with CRS treated with dupilumab, omalizumab, mepolizumab, benralizumab or reslizumab; studies published in English reporting outcomes in sense of smell using a psychophysical and/or subjective tools. Exclusion criteria covered reports that did not assess CRSwNP, smell loss evaluated with a different method according to mentioned inclusion criteria, review articles and expert opinion. No source of funding is available. Dupilumab has demonstrated rapid and sustained long-term improvement in smell in clinical trials and real-life. Omalizumab improves smell at 24w with a long-term maintenance but do not reach clinically relevant improvement. Mepolizumab and benralizumab improved smell at long-term measured with a subjective scale. No studies regarding the improvement of smell in patients with CRSwNP treated with reslizumab were found. Indirect comparisons by meta-analysis consistently conclude that dupilumab is the most effective biologic to improve the sense of smell. Dupilumab may have the highest efficacy in improving sense of smell, compared to omalizumab, mepolizumab and benralizumab.

Citation

B Barroso, M Valverde-Monge, D Betancor, A Gómez-López, C Villalobos-Vildas, B González-Cano, J Sastre. Smell improvement in chronic rhinosinusitis with nasal polyps with monoclonal antibodies: a systematic review. Journal of investigational allergology & clinical immunology. 2023 Sep 04:0

PMID: 37669083

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