Postoperative Anti‐IgE Therapy for Chronic Rhinosinusitis With Nasal Polyps and Asthma: Efficacy and Prognostic Factors

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BACKGROUND: Omalizumab has demonstrated efficacy in treating chronic rhinosinusitis (CRS) with nasal polyps and comorbid asthma (NPwAS) in preoperative settings. However, real-world evidence regarding its postoperative application remains limited. This study aimed to assess the effectiveness and safety of omalizumab in managing NPwAS following endoscopic sinus surgery (ESS), and to identify predictors for treatment response. METHODS: This prospective observational study enrolled 60 NPwAS patients who underwent ESS between January 2020 and March 2023. Participants were divided into two groups: Control group (receiving standard care: nasal saline lavage and budesonide nasal spray) and Omalizumab group (receiving omalizumab in addition to standard care). Disease assessments, including total nasal symptom score (TNSS), visual analog scale (VAS) score, asthma control test (ACT), and sino-nasal outcome test-22 (SNOT-22), were conducted at baseline and 6 months post-treatment. Blood and nasal polyp tissue samples were collected to explore potential predictors. CRS disease control was categorized as controlled, partly controlled, or uncontrolled based on the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). RESULTS: Thirty patients in the Omalizumab group and 28 in the Control group completed the treatment and follow-up. At 6 months, CRS control was significantly better in the Omalizumab group compared to the Control group, with response rates of 40% and 14.3%, respectively (p = 0.009). The Omalizumab group also demonstrated greater mean improvements from baseline in TNSS, loss of smell score, and SNOT-22 score compared to the Control group. The treatment exhibited a favorable safety profile. CONCLUSIONS: Omalizumab significantly improved clinical outcomes in NPwAS patients 6 months post-surgery, underscoring its potential as an effective adjunctive therapy in the postoperative management of NPwAS.

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