xRead - Olfactory Disorders (September 2023)

REVIEW ARTICLE

Effect of monoclonal antibodies on olfactory dysfunction caused by chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis Nikolaos Tsetsos, MD, MSc 1 , Konstantinos Markou, MD, PhD 2 and Iordanis Konstantinidis, MD, PhD 2

Conclusion: This is the first meta-analysis presenting clini cal outcomes with regard to olfactory function in CRSwNP patients who had been treated with monoclonal antibodies. The positive effect of biologic treatment on the olfactory function of these patients requires further study so that the sustainability of results and duration of treatment can be determined. C 2020 ARS-AAOA, LLC. KeyWords: olfaction; biologics; chronic rhinosinusitis; nasal polyps; functional endoscopic sinus surgery How to Cite this Article : Tsetsos N, Markou K, Konstantinidis I. Effect of mon oclonal antibodies on olfactory dysfunction caused by chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis. Int Forum Allergy Rhinol . 2020;10:893–900. Although the exact pathogenesis of CRS-induced olfactory dysfunction remains elusive, olfactory loss is likely due to a combination of blocked olfactory cleft from edematous mu cosa or polyposis and the structural changes to the olfactory neuroepithelium from chronic inflammation. 8 Several stud ies have recently shown that olfactory dysfunction leads to a significantly reduced quality of life in both main pheno types of CRS. 9 Impaired interindividual relationships, de pression, isolation, diminished food enjoyment, and safety issues are some of the consequences of impaired olfactory function. 10,11 In addition, unlike hearing or vision loss, ol factory dysfunction has been associated with an increased risk of mortality in older adults. 12 In CRSwNP-related olfactory dysfunction, standard medical treatment includes topical nasal steroids, nasal washings, antibiotic treatment, or systemic steroids in se lected cases. When conservative treatment fails and there are persistent symptoms, endoscopic sinus surgery is the next therapeutic option for CRSwNP patients. However, it is not recommended when anosmia is the sole symptom, as the outcome cannot be predicted. 3 Although the positive effects of nasal sinus surgery on symptom relief, quality of life, and nasal endoscopy have been well documented, the effect of functional endoscopic sinus surgery (FESS) on

Background: Olfactory dysfunction is a common complaint in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The purpose of this article is to critically review all published literature regarding the impact of monoclonal antibodies on CRSwNP-related olfactory dysfunction. Methods: An electronic literature search was performed in MEDLINE, ScienceDirect, the Cochrane Library electronic databases, and multiple trial registries, followed by exten sive hand-searching for the retrieval of relevant studies. Results: Seven trials with a total of 957 patients were even tually identified and systematically reviewed. Six of 7 stud ies showed that biologic therapy can improve olfactory dysfunction when compared with placebo. Overall, these biologic agents were considered safe and well-tolerated. No cases of olfactory deterioration or olfactory loss were reported. C hronic rhinosinusitis (CRS) is a complex inflamma tory disorder affecting approximately 12% of the gen eral population in Western countries and has a substan tial impact on patients’ quality of life. 1,2 It is characterized by a chronic inflammation of sinonasal mucosa clinically presenting with nasal obstruction, anterior/posterior rhi norrhea, facial pain/pressure, and/or loss or reduction of smell. 3 CRS can be divided into 2 main phenotypes: CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). 4 Olfactory dysfunction is a common complaint and af fects approximately 65% to 80% of patients with CRS. 5-7 1 Department of Otorhinolaryngology–Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece; 2 2nd Academic Otorhinolaryngology Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece Correspondence to: Nikolaos Tsetsos, MD, MSc, Otorhinolaryngology Head and Neck Surgery Department, “G. Papanikolaou” General Hospital, Thessaloniki, Greece; e-mail: tsetsosnikos@yahoo.gr Potential conflict of interest: None provided. Received: 3 March 2020; Revised: 24 March 2020; Accepted: 27 March 2020 DOI: 10.1002/alr.22576 View this article online at wileyonlinelibrary.com.

International Forum of Allergy & Rhinology, Vol. 10, No. 7, July 2020

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