Evaluation of Asthma Control in Patients with and without Sinonasal Polyps following Treatment with Biologic Agents

Background: The effects of biologics on severe asthmatics with chronic rhinosinusitis with sinonasal polyposis (CRSwNP) have not been well established. This study evaluates overall control of asthma in patients with and without sinonasal polyps following initiation of biologics therapy. Methods: Retrospective review of patients with asthma treated with a biologic agent (benralizumab, omalizumab, dupilumab, mepolizumab) and CRSwNP. Charts were assessed for ACT scores at time of biologic enrollment and at 4-7 months. Results: 82 patients met inclusion criteria; 42 (52.5%) patients with asthma and 40 (47.5%) with concurrent sinonasal polyps. The average ACT score for the non-polyp cohort was 13.16 + 4.12 at baseline, and 16.45 + 4.79 at long term follow-up; 15.85 + 3.13 and 20.19 + 1.68 in patients with polyps at both time points respectively. Patients with polyps had better control of their asthma at baseline (p=0.001), however both cohorts had overall poor baseline asthma control (ACT\u3c19). Patients with polyps continued to have significantly better overall control of their asthma at long term follow up (p\u3c0.001) and, on average, were able to achieve sustained asthma control (mean ACT = 20.19), after initiation of biologic therapy. Conclusions: Patients with and without sinonasal polyps who begin biologic therapy are shown to have significant improvements in their ACT score at follow-up. In addition, patients with polyps are shown to have significantly better control of their asthma while on biologics than patients with no polyps. Comorbid CRSwNP may predict response to biologic therapy in those with severe asthma (SA)