High Discontinuation Rates of Peroral ASA Treatment for CRSwNP: A Real-World Multicenter Study of 171 N-ERD Patients

Anu Laulajainen-Hongisto, Heikki Turpeinen, Seija I. Vento, Jura Numminen, Johanna Sahlman, Paula Kauppi, Paula Virkkula, Maija Hytönen, Sanna Toppila-Salmi

Research output: Contribution to journalArticleScientificpeer-review

3 Citations (Scopus)

Abstract

Background: Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) consists of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and NSAID intolerance. Acetylsalicylic acid treatment after desensitization (ATAD) is a treatment option for uncontrolled N-ERD. Objective: To evaluate peroral ATAD's long-term effectiveness on CRSwNP disease control. Methods: The retrospective data (patient characteristics, sinus surgeries before ATAD, ATAD, follow-up data [2019]) were collected from patient records of 171 patients with N-ERD (102 ATAD patients, 69 controls with CRSwNP+N-ERD without ATAD) who underwent tertiary hospital consultation from 2001 to 2017. Outcome measurements were ATAD discontinuation, revision sinus surgery, and corticosteroid and antibiotic courses for airway infections during 2016-2019. Associations were analyzed by survival and nonparametric methods. Results: The ATAD group had more tissue eosinophilia, symptoms, and sinus surgeries before ATAD than others. The ATAD discontinuation rate was 63%, independent of ATAD dose or duration, usually due to side effects. Compared with the N-ERD group without ATAD, ATAD (mean duration, 2.9 years) did not affect the revision endoscopic sinus surgery rate (P = .21, by the log-rank test) or the number of peroral corticosteroid courses per year (P > .05, by the Mann-Whitney U-test) during the follow-up (mean, 7.6 years) despite the dose or duration of ATAD. Conclusions: The discontinuation rate of ATAD was high (63%), and ATAD did not affect revision sinus surgery rate nor the need of peroral corticosteroids during follow-up. However, the remaining 37% of the ATAD group did continue the treatment, indicating that they may have benefited from ATAD.

Original languageEnglish
Pages (from-to)3565-3574
Number of pages10
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume8
Issue number10
DOIs
Publication statusPublished - 2020
Publication typeA1 Journal article-refereed

Keywords

  • Aspirin desensitization
  • Aspirin treatment after desensitization
  • Asthma
  • Chronic rhinosinusitis with nasal polyposis
  • Nonsteroidal anti-inflammatory drug exacerbated respiratory disease

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Immunology and Allergy

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