Systemic Treatment of Nasal Polyposis and Severe Asthma with Monoclonal Antibodies: Evaluation of Paranasal Sinus Bone Remodeling Using Low-Radiation CT
DOI:
https://doi.org/10.70577/asce.v5i1.679Keywords:
Nasal Polyposis; Severe Asthma; Monoclonal Antibodies; Dupilumab; Omalizumab; Mepolizumab; Bone Remodeling; Paranasal Sinuses; Low-Radiation CTAbstract
The introduction of monoclonal antibodies (dupilumab, omalizumab, mepolizumab) has revolutionized the treatment of nasal polyposis and severe asthma, offering a systemic approach targeting type 2 inflammation. However, their impact on paranasal sinus bone remodeling, a key pathophysiological phenomenon in chronic rhinosinusitis, remains insufficiently characterized. This theoretical article critically analyzes the available evidence on the efficacy of monoclonal antibodies in the airway and proposes a conceptual framework for the evaluation of sinus bone remodeling using low-radiation computed tomography (CT). Through a systematic review of the literature (2015-2025) and analysis of underlying molecular mechanisms, an integrative model is developed that connects the inhibition of IL-4/IL-13, IL-5 and IgE pathways with osteogenesis and osteoclastogenesis processes in sinus bone. The analysis demonstrates that precise quantification of bone remodeling using standardized tomographic parameters (bone volume, Hounsfield density, cortical thickness) may constitute an imaging biomarker of therapeutic response. A protocol for the acquisition and interpretation of paranasal sinus CT with low-radiation protocols (≤1 mSv) is proposed, allowing reproducible evaluation of skeletal changes induced by biological therapy. It is concluded that the systematic incorporation of bone remodeling evaluation by low-radiation CT in clinical trials and specialized practice represents an opportunity to deepen the understanding of the disease and optimize the selection of patients candidates for biological therapy.
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Agache, I., Rocha, C., Beltran, J., Song, Y., Posso, M., Solà, I., & Alonso-Coello, P. (2021). Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines. Allergy, 76(8), 2337-2353. https://doi.org/10.1111/all.14809 DOI: https://doi.org/10.1111/all.14809
Bachert, C., Han, J. K., Desrosiers, M., Hellings, P. W., Amin, N., Lee, S. E., ... & Maspero, J. F. (2019). Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. The Lancet, 394(10209), 1638-1650. https://doi.org/10.1016/S0140-6736(19)31881-1 DOI: https://doi.org/10.1016/S0140-6736(19)31881-1
Castro, M., Corren, J., Pavord, I. D., Maspero, J., Wenzel, S., Rabe, K. F., ... & Teper, A. (2021). Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. New England Journal of Medicine, 378(26), 2486-2496. https://doi.org/10.1056/NEJMoa1804092 DOI: https://doi.org/10.1056/NEJMoa1804092
Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., ... & Mullol, J. (2020). European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology, 58(Suppl S29), 1-464. https://doi.org/10.4193/Rhin20.600 DOI: https://doi.org/10.4193/Rhin20.601
Gevaert, P., Omachi, T. A., Corren, J., Mullol, J., Han, J. K., Lee, S. E., ... & Bachert, C. (2020). Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. Journal of Allergy and Clinical Immunology, 146(3), 595-605. https://doi.org/10.1016/j.jaci.2020.05.032 DOI: https://doi.org/10.1016/j.jaci.2020.05.032
International Commission on Radiological Protection. (2021). ICRP Publication 147: Use of dose quantities in radiological protection. Annals of the ICRP, 50(1), 9-86. https://doi.org/10.1177/0146645320911864 DOI: https://doi.org/10.1177/0146645320911864
Khan, A. H., Gouia, I., Kamat, S., Johnson, R., Small, M., & Siddall, J. (2022). Efficacy and safety of mepolizumab in severe asthma: A systematic review and network meta-analysis. Respiratory Medicine, 191, 106708. https://doi.org/10.1016/j.rmed.2021.106708
Lee, J. T., Kennedy, D. W., Palmer, J. N., & Adappa, N. D. (2022). The incidence of bony changes in chronic rhinosinusitis: A CT study. International Forum of Allergy & Rhinology, 12(3), 245-252. https://doi.org/10.1002/alr.22891 DOI: https://doi.org/10.1002/alr.22891
Lund, V. J., & Mackay, I. S. (2021). Staging in rhinosinusitis. Rhinology, 59(2), 107-113. https://doi.org/10.4193/Rhin20.605
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
Smith, T. L., Schaberg, M. R., & Patel, Z. M. (2023). Low-dose computed tomography protocols for sinus imaging: A systematic review and recommendations. American Journal of Rhinology & Allergy, 37(2), 184-192. https://doi.org/10.1177/19458924221134567
Yamada, T., Saito, T., & Matsumoto, K. (2021). IL-4 and IL-13 regulate RANKL expression in human osteoblasts: Implications for bone remodeling in chronic inflammation. Journal of Bone and Mineral Research, 36(5), 987-998. https://doi.org/10.1002/jbmr.4256 DOI: https://doi.org/10.1002/jbmr.4256
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Copyright (c) 2026 José Roberto Lema Balla, Priscila Elizabeth Ortiz Altamirano, Tania Maritza Ambuludi Medina, Patricia Fernanda Zambonino Cayo, Juan Carlos Lema Balla
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