Cystic fibrosis-related chronic rhinosinusitis: the key role of a comprehensive evaluation in the era of highly effective modulator therapy

Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6397-6404. doi: 10.1007/s00405-024-08888-3. Epub 2024 Aug 7.

Abstract

Background: Chronic rhinosinusitis (CRS) is prevalent in cystic fibrosis (CF), significantly affecting quality of life. The introduction of CFTR modulators, including elexacaftor-tezacaftor-ivacaftor (ETI), offers promise for improving sinonasal outcomes.

Methods: We conducted a retrospective cohort multicenter study analyzing electronic medical records of 45 adult CF patients with CRS, predominantly heterozygous for the ΔF508 mutation, treated with ETI between January 2018 and December 2023. Assessments included Sinonasal Outcome Test 22 (SNOT-22), Nasal Polyp Score (NPS), modified Lund-Kennedy Score (mLKS), Lund-Mackay Score (LMS), and olfactory function using smell loss visual analog scale (VAS) and Sniffin' Sticks identification test (SSIT).

Results: After 12 months of ETI therapy, significant improvements were observed in pulmonary function parameters (FEV1, FVC), CRS severity scores (SNOT-22, NPS, mLKS), radiological findings (LMS), and olfactory function. Subgroup analysis suggested enhanced efficacy in patients with prior endoscopic sinonasal surgery.

Conclusions: ETI therapy demonstrates comprehensive improvements in CRS and olfactory function in CF patients, highlighting the potential of CFTR modulators in managing sinonasal manifestations.

Keywords: CFTR modulators; Chronic rhinosinusitis; Cystic fibrosis; Elexacaftor-tezacaftor-ivacaftor; Smell.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aminophenols* / therapeutic use
  • Benzodioxoles / therapeutic use
  • Chloride Channel Agonists / therapeutic use
  • Chronic Disease
  • Cystic Fibrosis Transmembrane Conductance Regulator / genetics
  • Cystic Fibrosis* / complications
  • Cystic Fibrosis* / drug therapy
  • Cystic Fibrosis* / genetics
  • Cystic Fibrosis* / physiopathology
  • Cystic Fibrosis* / therapy
  • Drug Combinations*
  • Female
  • Humans
  • Indoles* / therapeutic use
  • Male
  • Middle Aged
  • Nasal Polyps / complications
  • Nasal Polyps / drug therapy
  • Nasal Polyps / therapy
  • Pyrazoles / therapeutic use
  • Pyridines / therapeutic use
  • Quality of Life
  • Quinolines
  • Quinolones* / therapeutic use
  • Retrospective Studies
  • Rhinitis* / complications
  • Rhinitis* / drug therapy
  • Rhinitis* / therapy
  • Rhinosinusitis
  • Sino-Nasal Outcome Test
  • Sinusitis* / complications
  • Sinusitis* / drug therapy
  • Sinusitis* / therapy
  • Thiophenes / therapeutic use
  • Treatment Outcome
  • Young Adult

Substances

  • Aminophenols
  • Drug Combinations
  • Quinolones
  • Indoles
  • Benzodioxoles
  • Cystic Fibrosis Transmembrane Conductance Regulator
  • Pyrazoles
  • Pyridines
  • elexacaftor, ivacaftor, tezacaftor drug combination
  • Thiophenes
  • Chloride Channel Agonists
  • Quinolines