Un Análisis Retrospectivo de Serie de Casos Multicéntrico de la Remodelación Ósea Sinusal Mediante Tomografía de Haz Cónico de Baja Radiación en Pacientes con Poliposis Nasal y Asma Grave en Tratamiento Biológico

Evelyn Giomaira Guamán Tibán; Isabella María Cornejo Cruz; Karol Melissa Tituana Tinoco; Ana Paula Alarcón Espinoza; Karen Joseline  Achig Coronel

doi:10.70577/asce.v5i3.1094

Authors

Evelyn Giomaira Guamán Tibán Investigador Independiente https://orcid.org/0009-0008-7368-5027
Isabella María Cornejo Cruz SOLCA https://orcid.org/0009-0001-1393-000X
Karol Melissa Tituana Tinoco Investigador Independiente https://orcid.org/0009-0005-8986-8512
Ana Paula Alarcón Espinoza Medikal https://orcid.org/0009-0006-8091-6001
Karen Joseline Achig Coronel Fundación Municipal de la Mujer y el Niño https://orcid.org/0000-0002-5431-561X

DOI:

https://doi.org/10.70577/asce.v5i3.1094

Keywords:

nasal polyposis; severe asthma; monoclonal antibodies; bone remodeling; osteitis; cone beam computed tomography

Abstract

Nasal polyposis (NP) and severe asthma (SA) are clinical manifestations of type 2 inflammation, associated with significant tissue remodeling, including bone changes (osteitis). The impact of monoclonal antibodies (mAb) on this bone component remains insufficiently characterized. The objective of this study was to quantitatively evaluate changes in sinonasal bone remodeling using low-dose cone beam computed tomography (CBCT-LD) in patients with NP and SA after 12 months of biologic therapy. A retrospective, multicenter case series analysis was conducted, including 110 adult patients with bilateral NP (Nasal Polyp Score ≥5) and uncontrolled SA (ACQ-7 ≥1.5) who initiated treatment with dupilumab, omalizumab, mepolizumab, or benralizumab. CBCT-LD images were acquired at baseline (T0) and at 12 months (T12). A semiautomated algorithm was developed to quantify Sinus Wall Thickness (SWT, in mm) in six anatomical regions and a volumetric Global Osteitis Index (GOI). Clinical outcomes assessed included the SNOT-22 questionnaire, Sniffin' Sticks olfactory test, FEV1%, and oral corticosteroid (OCS) dose. Results showed that dupilumab induced the greatest reduction in both SWT (-18.7%, p<0.001) and GOI (-22.5%, p<0.001). Significant reductions in SWT were also observed with mepolizumab (-12.3%, p=0.002), benralizumab (-9.1%, p=0.01), and omalizumab (-5.4%, p=0.03). For GOI, benralizumab showed a significant reduction (-15.8%, p=0.004), whereas reductions with mepolizumab (-7.1%, p=0.06) and omalizumab (-4.2%, p=0.18) did not reach statistical significance. The reduction in SWT in the anterior ethmoid wall strongly correlated with improvement in SNOT-22 (r=0.71, p<0.001) and olfactory function (r=0.64, p<0.001). The mean effective dose of CBCT-LD was 0.08 mSv. It is concluded that treatment with mAb, particularly dupilumab, induces a significant and quantifiable regression of pathological bone remodeling, closely associated with clinical improvement. CBCT-LD emerges as a safe and valid tool for assessing structural biomarkers of response to biologic therapy.

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