xRead - Olfactory Disorders (September 2023)

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559

PATEL et al.

TABLE IX.5 Evidence for CRSwNP-related olfactory loss management with oral antibiotic therapy

Study design Study groups

Clinical end point VAS (0–10) Data collection

Study

Year

LOE

Conclusions

Compared with placebo, doxycycline did not demonstrate significantly greater improvement in VAS at any time point. Compared with placebo, there was no significant benefit noted in the erythromycin group on SS at any time point Compared with baseline, all groups demonstrated significant improvement Compared with control (MF NS), the clarithromycin × 24 week group was significantly improved on SS at week 6 only All remaining time Compared with baseline, significant improvement was noted Compared with placebo, there was no significant benefit noted in the points showed no no significant benefit in the clarithromycin groups

VanZele et al 1380

2010 2

RCT

CRSwNP (N = 47) Studyarms Oral doxycycline × 20 days (n = 14) Oral placebo × 20days (n = 19) CRS (N = 58) Studyarms Oral erythromycin 250 mgdaily (n = 29) Oral placebo (n = 29) CRSwNP (N = 66) Following ESS: Studyarms MFNS (n = 22) Oral clarithromycin 250 mg once daily × 12 weeks (n = 22) Oral clarithromycin 250 mgdaily × 24weeks (n = 22) CRSwNP (N = 40) Studyarm: Oral clarithromycin 500 mg twice daily for 8 weeks (n = 40) CRSwNP(n = 31) Oral azithromycin 500 mg once daily for 3 days, then weekly for 11weeks (n = 30)Oral placebo (n = 30) CRSsNP (N = 29) and

points: week 1, week 2, week 4, week 8, week 12

Haxel

2014

2

RCT

SS-ID Data collection

et al 1362

points: week 2, week 14, week 26

SS-ID Data collection

Varvyanskaya et al 1364

2014

2

RCT

points: week 6, week 12, week 24

Dabirmoghaddam et al 1365

2013

3

Cohort

VAS (0–10) Data collection point: week 8

Videler 1366

SS-ID VAS (0–10) Data collection

2011

2

RCT

points: week 6, week 12, week 14

azythromycin group on SS or VAS at any timepoint

CRS = chronic rhinosinusitis; CRSsNP = chronic rhinosinusitis without nasal polyps; CRSwNP = chronic rhinosinusitis with nasal polyps; LOE = level of evidence; MF = mometasone furoate; RCT = randomized controlled trial; SS = Sniffin’ Sticks; SS-ID = Sniffin’ Sticks identification only; VAS = visual analog scale.

Cost : Direct: High monetary cost per injection. Indirect: Variable depending on whether home or in office injections. Benefits-harm assessment : Likely benefit over harm for OD in patients with CRSwNP not responsive to medical and surgical standard of care. Value judgments : Benefits are lost if therapy is dis continued and costs are an important consideration. Consider for patients with CRSwNP with concomi-

part of a shared decision-making process, but other bio logics with more robust olfactory outcomes may be a better choice for improvement in this specific symptom. Omalizumab for OD in patients with CRSwNP Aggregate grade of evidence : B (Level 2: four studies). Benefit : Omalizumab improves subjective and objec tive olfactory measures of OD compared with placebo. Harm : Injection site reactions, cold symptoms, joint/muscle pain, risk for anaphylaxis (rare).