COMPARATIVE STUDY OF CHRONIC RHINOSINUSITIS MANAGEMENT STRATEGIES AND THEIR LONG‑TERM IMPACT ON NASAL MUCOSAL INFLAMMATION

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a widespread inflammatory disorder that is extremely morbid and recurrent even after conventional medical and surgical treatments. With the creation of the biologic therapies that target the type 2 inflammatory pathways, the situation in the sphere of therapy has changed, yet there is little comparative long-term data of the treatment options and reaction patterns to endotypes. To critically compare and contrast long-term effects of traditional pharmacotherapy, endoscopic sinu surgery (ESS) and biologic therapy (dupilumab, mepolizumab, omalizumab) on the inflammation of nasal mucosa, disease recurrence, quality of life and histopathological remodelling of patients with CRSwNP.A network was conducted of 47 studies (8412 patients with a mean follow up of 78.4 weeks) in order to conduct a meta-analysis and systematic review. The outcomes included the endoscopic scores, patient-reported outcomes, rate of surgery revision, histopathological parameters, biomarker dynamics, and safety profiles. Treatment response biomarkers were determined by conducting endotype-specific response analyses and prediction modeling. It was also shown that dupilumab is more efficient in the long run, the highest score change in endoscopy (0 -7.82 ± 1.45: -4.21 ± 0.98) and the lowest revision surgery rate (4.2% at 10 Histopathological analyses revealed dupilumab produced the most significant remodelling of the mucosa and hyperplasia of the goblet Serum IL-5 proved to be the most significant predictor of mepolizumab response (PPV: 0.81), and serum IgE was the predictor of omalizumab response (PPV: 0.85). ESS gave the quickest increase in mucociliary clearance but paid with an increase in revision operation rates (18.2% at 104 weeks) in comparison to biologic treatment. Biologic therapies in particular dupilumab therapy have been found to be more effective in long-term management of the disease, mucosal remodeling and quality of life in suitable patients with type 2-high CRSwNP compared to conventional therapies. Baseline biomarkers are ideal as they enable selection of endotypes and give the most optimal results, and this shift towards precision medicine in the case of managing refractory CRSwNP.