Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era
Abstract Background Chronic rhinosinusitis (CRS) is an inflammatory disease that may require biological therapy. Omalizumab is an anti-IgE biologic that was recently approved by the FDA and Health Canada for use in severe CRS with nasal polyps (CRSwNP) recalcitrant to intranasal corticosteroids. Dos...
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SAGE Publishing
2022-05-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | https://doi.org/10.1186/s40463-022-00580-y |
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| author | Austin Heffernan Jobanjit Phulka Andrew Thamboo |
| author_facet | Austin Heffernan Jobanjit Phulka Andrew Thamboo |
| author_sort | Austin Heffernan |
| collection | DOAJ |
| description | Abstract Background Chronic rhinosinusitis (CRS) is an inflammatory disease that may require biological therapy. Omalizumab is an anti-IgE biologic that was recently approved by the FDA and Health Canada for use in severe CRS with nasal polyps (CRSwNP) recalcitrant to intranasal corticosteroids. Dosing is based on weight and pre-treatment serum IgE, with elevated levels of the latter being an indication for biologic treatment according to EPOS and EUFOREA guidelines. The goal of this study was to identify variables that predict IgE-high type 2 inflammation and serve as indicators for biologic treatment in CRS. Methods Patients ≥ 19 yo diagnosed with CRS undergoing functional endoscopic sinus surgery were included retrospectively. Demographics, past medical history, preoperative blood work, Lund-Mackay (LM), Lund Kennedy (LK), and SNOT-22 scores were extracted. Descriptive statistics and binary logistic regression analyses were conducted. Model superiority was based on Nagelkerke R2 scores and receiver operating characteristic curves. Results Sixty-five patients, average age 49.96 ± 13.59 years, were included. Sixty-one binary logistic regression models for elevated serum IgE were created. Among the top 3 models, the best model had sensitivity, specificity, positive predictive value and negative predictive values of 82.1, 69.2, 80.0, and 72.0. All performance measures except sensitivity exceeded the Canadian Biologics Guideline model. Serum eosinophils ≥ 300 cell/uL, CRSwNP and LM ≥ 17 increased the odds of elevated IgE. Conclusions IgE-high type-2 inflammation can be predicted by a model that includes eosinophil ≥ 300 cell/uL, CRSwNP, LM ≥ 17, asthma diagnosis and SNOT-22 ≥ 40. Patients meeting these parameters have a high pretest probability for elevated IgE and would benefit from IgE serology to determine qualification for omalizumab. This could reduce unwarranted IgE serology in patients with CRSwNP but also target a patient population for further workup that will lead to optimization of resource allocation and improve healthcare equity in rural and remote areas within Canada. |
| format | Article |
| id | doaj-art-66c1317a282f4a0187beccae0ee8e7b1 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2022-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-66c1317a282f4a0187beccae0ee8e7b12025-02-03T10:54:11ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162022-05-015111910.1186/s40463-022-00580-yImproving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic eraAustin Heffernan0Jobanjit Phulka1Andrew Thamboo2Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of British ColumbiaDivision of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of British ColumbiaDivision of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of British ColumbiaAbstract Background Chronic rhinosinusitis (CRS) is an inflammatory disease that may require biological therapy. Omalizumab is an anti-IgE biologic that was recently approved by the FDA and Health Canada for use in severe CRS with nasal polyps (CRSwNP) recalcitrant to intranasal corticosteroids. Dosing is based on weight and pre-treatment serum IgE, with elevated levels of the latter being an indication for biologic treatment according to EPOS and EUFOREA guidelines. The goal of this study was to identify variables that predict IgE-high type 2 inflammation and serve as indicators for biologic treatment in CRS. Methods Patients ≥ 19 yo diagnosed with CRS undergoing functional endoscopic sinus surgery were included retrospectively. Demographics, past medical history, preoperative blood work, Lund-Mackay (LM), Lund Kennedy (LK), and SNOT-22 scores were extracted. Descriptive statistics and binary logistic regression analyses were conducted. Model superiority was based on Nagelkerke R2 scores and receiver operating characteristic curves. Results Sixty-five patients, average age 49.96 ± 13.59 years, were included. Sixty-one binary logistic regression models for elevated serum IgE were created. Among the top 3 models, the best model had sensitivity, specificity, positive predictive value and negative predictive values of 82.1, 69.2, 80.0, and 72.0. All performance measures except sensitivity exceeded the Canadian Biologics Guideline model. Serum eosinophils ≥ 300 cell/uL, CRSwNP and LM ≥ 17 increased the odds of elevated IgE. Conclusions IgE-high type-2 inflammation can be predicted by a model that includes eosinophil ≥ 300 cell/uL, CRSwNP, LM ≥ 17, asthma diagnosis and SNOT-22 ≥ 40. Patients meeting these parameters have a high pretest probability for elevated IgE and would benefit from IgE serology to determine qualification for omalizumab. This could reduce unwarranted IgE serology in patients with CRSwNP but also target a patient population for further workup that will lead to optimization of resource allocation and improve healthcare equity in rural and remote areas within Canada.https://doi.org/10.1186/s40463-022-00580-yChronic RhinosinusitisImmunoglobulin-EBiomarkersEndotypeMonoclonal antibodiesBiologics |
| spellingShingle | Austin Heffernan Jobanjit Phulka Andrew Thamboo Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era Journal of Otolaryngology - Head and Neck Surgery Chronic Rhinosinusitis Immunoglobulin-E Biomarkers Endotype Monoclonal antibodies Biologics |
| title | Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era |
| title_full | Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era |
| title_fullStr | Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era |
| title_full_unstemmed | Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era |
| title_short | Improving predictability of IgE-high type 2 chronic sinusitis with nasal polyps in the biologic era |
| title_sort | improving predictability of ige high type 2 chronic sinusitis with nasal polyps in the biologic era |
| topic | Chronic Rhinosinusitis Immunoglobulin-E Biomarkers Endotype Monoclonal antibodies Biologics |
| url | https://doi.org/10.1186/s40463-022-00580-y |
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