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

doi:10.1016/j.jaip.2020.06.063

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

J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3565-3574. doi: 10.1016/j.jaip.2020.06.063. Epub 2020 Jul 18.

Authors

Anu Laulajainen-Hongisto¹, Heikki Turpeinen², Seija I Vento³, Jura Numminen⁴, Johanna Sahlman⁵, Paula Kauppi², Paula Virkkula³, Maija Hytönen³, Sanna Toppila-Salmi⁶

Affiliations

¹ Inflammation Centre, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: anu.laulajainen-hongisto@hus.fi.
² Inflammation Centre, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴ Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.
⁵ Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.
⁶ Inflammation Centre, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland.

PMID: 32693216
DOI: 10.1016/j.jaip.2020.06.063

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.

Keywords: Aspirin desensitization; Aspirin treatment after desensitization; Asthma; Chronic rhinosinusitis with nasal polyposis; Nonsteroidal anti-inflammatory drug exacerbated respiratory disease.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aspirin
Chronic Disease
Humans
Nasal Polyps* / epidemiology
Nasal Polyps* / surgery
Retrospective Studies
Rhinitis* / drug therapy
Rhinitis* / epidemiology
Sinusitis* / drug therapy
Sinusitis* / epidemiology

Substances

Aspirin