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Reprinted by permission of Int Forum Allergy Rhinol. 2014; 4(7):533-541.

OR I G I NAL ART I CLE

Efficacy of long-term low-dose macrolide therapy in preventing early recurrence of nasal polyps a er endoscopic sinus surgery Anastasia Varvyanskaya, MD and Andrey Lopatin, MD, Dr Med Sci

Background: This study assessed efficacy of clarithromycin “long-term” macrolide therapy as an adjunct to mainte- nance therapy with nasal corticosteroids to prevent recur- rence of nasal polyps (NP) a er functional endoscopic si- nus surgery (FESS). Methods: A total of 66 patients with chronic rhinosinusitis and bilateral NP were randomized into 3 study arms, 22 pa- tients in each arm. A er FESS, patients in the first and sec- ond groups were treated with clarithromycin 250 mg/day for 12 and 24 weeks, respectively, whereas patients in the third group did not receive any clarithromycin. Patients in all 3 groups received maintenance therapy with mometa- sone furoate 400 μ g/day. Patient assessment was con- ducted before the surgery and 6, 12, and 24 weeks af- ter surgery, using a visual analogue scale (VAS), 20-item SinoNasal Outcome Test (SNOT-20), acoustic rhinometry, rhinomanometry, saccharin transit time, nasal endoscopy, computed tomography (CT) of paranasal sinuses, and mea- surement of the level of eosinophil cationic protein (ECP) in their nasal secretions. Results: The study confirmed efficacy of “long-term” macrolide therapy, resulting in significant improvement of all parameters except acoustic rhinometry and VAS in both C hronic rhinosinusitis (CRS) often occurs in associa- tion with nasal polyps (NP). In 1 study CRS with NP (CRSwNP) was diagnosed in 4% of an entire population 1 and is associated with bronchial asthma (BA) in 7% to 13% of cases. 2 In addition, aspirin-exacerbated respira- tory disease (AERD) and NP are present in a large number of patients (ranging, 36-96%). 3 In CRSwNP the predomi- nate inflammatory cell is the eosinophil, which is found in Ear, Nose, and Throat (ENT) Clinic, Sechenov First Moscow State Medical University, Moscow, Russia Correspondence to: Andrey S. Lopatin, MD, Dr Med Sci., Partizanskayast. 33, bld 1, 55, 121351, Moscow, Russia; e-mail: lopatin.andrey@inbox.ru Potential conflict of interest: None provided. Received: 30 July 2013; Revised: 4 February 2014; Accepted: 4 February 2014 DOI: 10.1002/alr.21318 View this article online at wileyonlinelibrary.com.

clarithromycin groups as compared to the control. Concen- tration of ECP in the nasal secretions increased dramat- ically a er surgery, then returned to baseline levels a er 12 and 24 weeks of treatment with clarithromycin. In the control group, ECP level continued to increase and was significantly higher at the endpoint. Both groups with clar- ithromycin showed significantly be er endoscopic and CT scores than the control group at the end point. “Long-term” low-dose clarithromycin 250 mg/day is able to control eosinophilic inflammation and prevent early relapse of NP a er FESS. C 2014 ARS- AAOA, LLC. Key Words: chronic rhinosinusitis; endoscopic sinus surgery; medical therapy of chronic rhinosinusitis; computed tomography; SNOT-20 How to Cite this Article : Varvyanskaya A, Lopatin A. Efficacy of long-term low-dose macrolide therapy in preventing early recurrence of nasal polyps a er endoscopic sinus surgery. Int Forum Allergy Rhinol . 2014;4:533–541. both the tissue and in the airway mucus in almost all pa- tients with CRSwNP. Although the role of infection (neu- trophilic inflammation) has been investigated it does not seem to be a primary factor in the development of CR- SwNP although CRSwNP is associated with BA. Allergy seems to be a comorbid condition and not a primary factor in the development of CRSwNP. 4 At present, neither med- ical nor surgical treatment can ensure permanent control or enduring cure. Currently the only proven treatment for effective control of CRSwNP is topical nasal steroid sprays with or without systemic glucocorticosteroids (GCS). Re- current CRSwNP is not always prevented even with sys- temic GCS and the side effects can be serious, including cataracts and vertebral collapse. 5 Because disease control can be difficult even with systemic GCS we decided to study treatment with “long-term” therapy (3-6 months and more) using low dose macrolide antibiotics. Apparently Conclusion:

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