Cochrane · systematic review · CD013513
Biologics for chronic rhinosinusitis
Chong, L-Y, Piromchai, P, Sharp, S, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
23
No studies
1
Included studies
NR
No studies 1 · 4.2%Ungraded 0 · 0%Very low 8 · 33.3%Low 8 · 33.3%Moderate 5 · 20.8%High 2 · 8.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsAnti‐IL‐4Rα mAb (dupilumab) compared to placebo (on top of topical steroids) for chronic rhinosinusitis
Population: patients with severe chronic rhinosinusitis with nasal polyps
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health‐related quality of life ‐ disease‐specific (SNOT‐22, range 0 to 110, lower = better) Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | no estimate extracted | 3 studies · 784 participants | High |
Disease severity ‐ VAS (range 0 to 10, lower = better) Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | no estimate extracted | 3 studies · 784 participants | Moderate Downgraded: risk of bias |
Serious adverse events Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | RR 0.47 [0.29, 0.76] | 3 studies · 782 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Avoidance of surgery ‐ number of patients who had surgery as rescue treatment Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | RR 0.17 [0.05, 0.52] | 2 studies · 725 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Extent of disease: endoscopic nasal polyp score (range 0 to 8, lower = better) Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | no estimate extracted | 3 studies · 784 participants | Moderate Downgraded: risk of bias |
Extent of disease: CT scan score (Lund‐Mackay, range 0 to 24, lower = better) Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | no estimate extracted | 3 studies · 784 participants | High |
Health‐related quality of life ‐ generic (EQ‐5D visual analogue scale, range 0 to 100, higher = better) Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | no estimate extracted | 3 studies · 766 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events ‐ nasopharyngitis, including sore throat (longest available data) Anti‐IL‐4Rα mAb (dupilumab) vs placebo (on top of topical steroids) | RR 0.95 [0.72, 1.25] | 3 studies · 783 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Anti‐IL‐5 mAb (mepolizumab) compared to placebo (on top of topical steroids) for chronic rhinosinusitis
Population: patients with severe chronic rhinosinusitis with nasal polyps
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health‐related quality of life ‐ disease‐specific (SNOT‐22, range 1 to 100, lower = better) Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | no estimate extracted | 1 study · 105 participants | Low Downgraded: imprecision |
Disease severity ‐ VAS (range 0 to 10, lower = better) Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | no estimate extracted | 1 study · 72 participants | Very low Downgraded: imprecision |
Serious adverse events Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | RR 1.57 [0.07, 35.46] | 2 studies · 135 participants | Very low Downgraded: imprecision |
Avoidance of surgery ‐ patients still meeting the criteria for surgery At end of Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | RR 0.78 [0.64, 0.94] | 2 studies · 135 participants | Very low Downgraded: imprecision |
Extent of disease ‐ endoscopic score Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | no estimate extracted | 2 studies · 137 participants | Very low Downgraded: imprecision |
Extent of disease ‐ CT scan score (Lund‐Mackay, range 0 to 24, lower = better) Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | no estimate extracted | 1 study · 27 participants | Very low Downgraded: imprecision |
Health‐related quality of life ‐ generic, measured using the EQ‐5D visual analogue scale (range 0 to 100; 0 = worst imaginable health state, 100 = best imaginable health state) Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | no estimate extracted | 1 study · 105 participants | Low Downgraded: imprecision |
Adverse events ‐ nasopharyngitis, including sore throat Anti‐IL‐5 mAb (mepolizumab) vs placebo (on top of topical steroids) | RR 0.73 [0.36, 1.47] | 2 studies · 135 participants | Low Downgraded: imprecision |
Anti‐IgE mAb (omalizumab) compared to placebo (on top of topical steroids) for chronic rhinosinusitis
Population: patients with chronic rhinosinusitis with nasal polyps
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health‐related quality of life ‐ disease‐specific (SNOT‐22, range 0 to 110, lower = better) Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | no estimate extracted | 2 studies · 265 participants | Moderate Downgraded: imprecision |
Disease severity, as measured by validated, patient‐reported symptom score Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | no estimate extracted | NR | No studies |
Serious adverse events Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | RR 0.32 [0.05, 2] | 5 studies · 329 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Avoidance of surgery Nasal polyp score ≤4 (≤ 2 on each side) and an improvement in SNOT‐22 score of ≥ 8.9 points Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | RR 5.6 [1.99, 15.76] | 2 studies · 265 participants | Low Downgraded: imprecision |
Extent of disease: endoscopic nasal polyp score (range 0 to 8, lower = better) Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | no estimate extracted | 4 studies · 312 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Extent of disease: CT scan (lower score = better) Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | no estimate extracted | 2 studies · 47 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Health‐related quality of life ‐ generic (SF‐36) Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | no estimate extracted | 2 studies · 38 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events ‐ nasopharyngitis, including sore throat Anti‐IgE mAb (omalizumab) vs placebo (on top of topical steroids) | RR 0.71 [0.29, 1.73] | 5 studies · 329 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |