Biologics and Selected Upper- and Lower-Airway Outcomes in AERD Subgroups: A Systematic Review and Meta-Analysis.
Zusheng Du, Wei Liu, Yang Zheng et al.
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In 30 seconds
This systematic review and meta-analysis assessed biologics versus placebo for selected upper- and lower-airway outcomes in patients with aspirin-exacerbated respiratory disease (AERD) represented in randomized controlled trials. Eleven studies comprising 15 trials and 818 patients were included. Biologics significantly improved all six evaluated outcomes, including nasal polyp score, sinonasal symptoms, smell, asthma control, and lung function. The largest reported pooled effects included a 22-item Sino-Nasal Outcome Test mean difference of -19.16 (95% CI, -25.62 to -12.69) and an FEV1 mean difference of 0.29 L (95% CI, 0.21 to 0.37); all effects exceeded the respective minimal clinically important difference thresholds.
Key findings
- Nasal Polyp Score improved versus placebo (mean difference, -1.33 [95% CI, -2.07 to -0.59]).
- The 22-item Sino-Nasal Outcome Test improved (mean difference, -19.16 [95% CI, -25.62 to -12.69]).
- Asthma control improved on the 5-item Asthma Control Questionnaire (mean difference, -0.90 [95% CI, -1.32 to -0.48]).
- FEV1 increased by 0.29 L (95% CI, 0.21 to 0.37); all evaluated outcomes exceeded their minimal clinically important difference thresholds.
Why it matters
AERD affects both upper and lower airways, and conventional treatments may have limited efficacy with recurrence. This synthesis indicates that biologics studied in AERD subgroups can improve outcomes across both airway domains, including patient-reported symptoms and lung function. The findings help characterize the potential breadth of benefit while reflecting evidence drawn from trials not designed specifically for AERD.
What to keep in mind
AERD-specific randomized controlled trials remain scarce; the analysis therefore relies on AERD subgroups within trials of biologics.