xRead - Olfactory Disorders (September 2023)

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Tsetsos et al.

dupilumab were additionally administered mometasone nasal spray. Thus its efficacy as monotherapy cannot be evaluated. Although olfactory improvement was apparent across most study periods, it remains unclear what happens in the long term when patients discontinue monoclonal antibody treatment. Another significant point is that the studies showed a beneficial effect in olfaction in patients without previous surgery. Thus, it is unknown whether biologics would be as effective patients with previous surgery, especially those with multiple procedures. Last, although the significant im provement in olfactory function was consistent with the improvement in polyp burden and sinus opacifications, no direct comparison between these outcomes or statistical analyses were conducted in the included studies. It would be useful to have additional data available for other areas of interest, such as the olfactory cleft. Considering that bio logics are not a first-line treatment at the moment, and may be an additional option when surgery fails, we need further

studies in operated patients as they present distinct histo logic changes, presence of osteitis, etc, in order to reassess their efficacy. Conclusion Olfactory dysfunction is one of the major symptoms of CRS. It is difficult to alleviate with medical therapy and/or surgery, but most of the studies assessed showed a bene ficial effect of biologics on olfactory function. Specifically, dupilumab appears to offer the best results, with clear im provement of olfactory test measurements in all the stud ies. Comparable results were presented with the use of omalizumab and mepolizumab, yet high-quality trials with larger sample sizes need to be conducted. Better objective outcomes and longer follow-up are also needed to confirm the benefits and long-term efficacy of biologic therapy on olfaction in patients with CRSwNP. More studies are soon forthcoming, and therefore further evaluation will be nec essary in the short term as data rapidly emerge.

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