Background: Chronic rhinosinusitis (CRS) is a spectrum of inflammatory sinus diseases sinus which may persist over a period of 12 weeks. CRS can be differentiated into several clinical phenotypes, but this do not give too much idea about the underlying inflammatory mechanisms nor to direct to or predict outcome of applied therapeutic lines.
Objectives: Evaluation of outcome of treatment of CRS patients with anti-immunoglobulin E, omalizumab (OMA) and the value of pre-treatment serum periostin (POSTN) as predictor for outcome.
Patients & Methods: The study included 86 CRS patients free of nasal polyposis (NP) divided into two groups; group A received conventional and group B received OMA therapy and 10 control subjects. All patient underwent subjective evaluation using Sino-Nasal Outcome Test-22 score (SNOT-22 score) and objectively using endoscopic and CT scorings. Serum IgE and POSTN levels were ELISA estimated pre-treatment and POSTN levels were estimated at end of treatment. Study outcome was defined as response to provided therapy.
Results: Thirty-nine patients were responded to applied therapies with significantly higher frequency of responders to OMA than conventional therapy (28 vs. 11) and 47 patients underwent surgery. Pre-treatment serum POSTN levels were significantly higher in patients than in controls, but were significantly decreased at end of treatment with significant difference versus pre-treatment levels and between patients received OMA or conventional therapy and between responders and non-responders in both groups. Pre-treatment serum POSTN levels were significantly correlated with subjective and objective scorings of CRS disease, but were inversely associated with outcome. ROC curve analysis defined serum POSTN level as the most significant predictor for therapeutic outcome. Kaplan-Meier regression analysis defined median value of 119.7 (±SE: 3.79) ng/ml as cutoff point for prediction of outcome.
Conclusion: Pre-treatment estimation of serum POSTN could be used for screening of CRS patients free of NP to detect those susceptible for its development and as a biomarker for the possible response to medical treatment. Anti-IgE therapy effectively reduced severity and symptoms of CRS and may allow surgery-sparing for a high percentage of patients.
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