Impact of Biologics on Nasal Symptoms in Severe Asthmatics: Findings From the PRISM Study

초록

Purpose: The sino-nasal outcome test (SNOT-22) is a patient-reported outcome measure for chronic rhinosinusitis (CRS), assessing treatment response after 6 months of biologic uses in patients with severe CRS. We investigated score changes in each domain of SNOT-22 with biologics in patients with severe asthma. Methods: A total of 229 patients with severe asthma and nasal symptoms were enrolled from a prospective, observational, multicenter cohort study. After 6 months of treatment with biologics or conventional GINA Step 4–5 management, SNOT-22 changes were evaluated by analyzing total and rhinological, extranasal rhinological, ear/facial, psychological, and sleep domain scores. Results: The adjusted odds ratio (OR) of being a responder was significantly higher for dupilumab in the total (OR, 2.29; 95% confidence interval [CI], 1.08–4.87), extranasal rhinological (OR, 2.80; 95% CI, 1.20–6.56), physiologic (OR, 2.23; 95% CI, 1.03–4.83), and sleep dysfunction (OR, 2.50; 95% CI, 1.14–5.47) domain scores of SNOT-22 than those for conventional or anti-interleukin (IL)-5 antibody treatment. After adjusting for the history of CRS diagnosis, dupilumab users had higher ORs for total SNOT-22 (OR, 2.20; 95% CI, 1.02–4.77) and extranasal rhinological (OR, 2.77; 95% CI, 1.16–6.60) scores. When SNOT-22 was plotted by the type of treatment at 0, 1, and 6 months, an overall trend of decreased total/domain scores of SNOT-22 was observed in the biologic-treated group compared to the conventional group, with the most pronounced decrease in dupilumab-treated group. Conclusions: Dupilumab demonstrates a significant improvement not only in total SNOT-22 scores but also in the extranasal rhinological, physiologic, and sleep dysfunction domain scores compared to conventional or anti-IL-5 treatment in patients with severe asthma and nasal symptoms. © © 2025 The Korean Academy of Asthma, Allergy and Clinical Immunology. The Korean Academy of Pediatric Allergy and Respiratory Disease. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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