xRead - Olfactory Disorders (September 2023)

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INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX-8 Evidence for CRSwNP-related olfactory loss management with omalizumab

Study design

Study

Year

LOE

Study groups

Clinical end point Subjective symptom score (0–3) UPSIT R Data collection points: week 8, week 16, week 24

Conclusions Compared with placebo, the

Gevaert

2020 2

RCT

CRSwNP (N = 138) Study arms: Omalizumab 75 to 600 mg every 2 to 4 weeks dosing (n = 72) Placebo (n = 66)

et al 220

omalizumab group demonstrated significantly greater improvement in subjective symptom score and UPSIT R at week 8 and this was sustained to week24 omalizumab group demonstrated significantly greater improvement in subjective symptom score and UPSIT R at week 8 and this was sustained to week24 omalizumab group demonstrated significantly greater benefit in subjective symptom score at week 16

Gevaert

2020 2

RCT

CRSwNP (N = 127) Study arms: Omalizumab 75 to 600 mg every 2 to 4 weeks dosing (n = 62) Placebo (n = 65)

Subjective symptom score UPSIT R Data collection points: week 8, week 16, week24

Compared with placebo, the

et al 220

Compared with baseline, the

Subjective symptom score Data collection point: week16

Gevaert

2013

2

RCT

CRSwNP (N = 24) Omalizumab standard dosing × 16weeks (n = 16) Placebo (n = 8)

et al 1415

Pinto

2010 2

RCT

CRSwNP (N = 14) Omalizumab standard dosing x 6 months (n = 7) Placebo (n = 7)

Subjective symptom score (0–3) UPSIT R Data collection point: month 3, month 5, month6

Compared with placebo, the

et al 1416

omalizumab group didnot

demonstrate any significant benefit in regards to subjective symptom score CRSwNP = chronic rhinosinusitis with nasal polyps; LOE = level of evidence; RCT = randomized controlled trial; UPSIT R = University of Pennsylvania Smell Identification Test.

Recommendation level :Option Intervention : The use of a short-term course of oral corticosteroid for OD in patients with CRSsNP is an option and should be individualized as part of a shared decision making approach. Longer-term use of oral steroids for OD in patients with CRSsNP has not been studied and carries increased risk of harm to the patient. Intranasal topical corticosteroids for OD in patients with CRSsNP Aggregate grade of evidence : A (Level 2: seven stud ies; Level 3: one study).

increased bone turnover, among others. Risks are greater with higher cumulative doses. Cost : Direct: Low monetary cost. Indirect: Minimal. Benefits-harm assessment : Not entirely clear because of lack of efficacy data, but possible benefits bal anced with low risks with short, low-dose treatment course. Value judgments : Clinicians should consider that many older patients may have smell loss independent of CRS.