Impact of Biologics on Nasal Symptoms in Severe Asthmatics: Findings From the PRISM Study

Purpose: The sino-nasal outcome test (SNOT-22) is a patient-reported outcome measure for chronic rhinosinusitis (CRS), assessing treatment response after 6 months of biologic uses in patients with severe CRS. We investigated score changes in each domain of SNOT-22 with biologics in patients with severe asthma. Methods: A total of 229 patients with severe asthma and nasal symptoms were enrolled from a prospective, observational, multicenter cohort study. After 6 months of treatment with biologics or conventional GINA Step 4–5 management, SNOT-22 changes were evaluated by analyzing total and rhinological, extranasal rhinological, ear/facial, psychological, and sleep domain scores. Results: The adjusted odds ratio (OR) of being a responder was significantly higher for dupilumab in the total (OR, 2.29; 95% confidence interval [CI], 1.08–4.87), extranasal rhinological (OR, 2.80; 95% CI, 1.20–6.56), physiologic (OR, 2.23; 95% CI, 1.03–4.83), and sleep dysfunction (OR, 2.50; 95% CI, 1.14–5.47) domain scores of SNOT-22 than those for conventional or anti-interleukin (IL)-5 antibody treatment. After adjusting for the history of CRS diagnosis, dupilumab users had higher ORs for total SNOT-22 (OR, 2.20; 95% CI, 1.02–4.77) and extranasal rhinological (OR, 2.77; 95% CI, 1.16–6.60) scores. When SNOT-22 was plotted by the type of treatment at 0, 1, and 6 months, an overall trend of decreased total/domain scores of SNOT-22 was observed in the biologic-treated group compared to the conventional group, with the most pronounced decrease in dupilumab-treated group. Conclusions: Dupilumab demonstrates a significant improvement not only in total SNOT-22 scores but also in the extranasal rhinological, physiologic, and sleep dysfunction domain scores compared to conventional or anti-IL-5 treatment in patients with severe asthma and nasal symptoms.