TY - JOUR
T1 - Long-term role of zileuton in the treatment of chronic rhinosinusitis in aspirin exacerbated respiratory disease
AU - Makary, Chadi A.
AU - Holmes, Thomas
AU - Unsal, Aykut
AU - Munjal, Ananya
AU - Ryan, Lindsey
AU - Reyes, Camilo
AU - Kountakis, Stilianos E.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Background: Chronic rhinosinusitis (CRS) in the setting of Aspirin Exacerbated Respiratory Disease (AERD) have high rate of treatment failure and disease recurrence. Objective: Evaluate the long-term effect of zileuton on sinonasal outcomes in patients with AERD. Methods: AERD patients were reviewed and divided into two cohorts, depending if they were treated with zileuton during their clinical course. Demographic data, 22-item sinonasal outcome test (SNOT-22), Lund-Kennedy (LK) endoscopy score, duration of treatment, and number of sinus surgeries performed were collected. Results: 40 AERD patients were included, with follow-up duration up to 10 years (avg of 5.2 years). All patients were treated with topical saline and budesonide irrigations, intranasal steroid spray, and montelukast. 19 patients had uncontrolled sinus disease requiring multiple steroid tapers and were switched from montelukast to zileuton (cohort 1, 47.5%) at some point in their treatment. 21 patients (cohort 2, 52.5%) never needed zileuton. The average duration of treatment with zileuton was 6 years. Patients who required zileuton had a worse SNOT-22 (32.1 vs 19, p = 0.117), worse LK score (8.1 vs 7.5, p = 0.504), and higher average number of surgeries (1.9 vs 1.6, p = 0.343). The outcomes in the zileuton cohort trended toward improvement, however these did not reach statistical significance with an improved SNOT-22 from 32.1 to 27.4 (p = 0.617) and LK score from 7.9 to 6.2 (p = 0.092); The addition of zileuton significantly lowered the number of surgeries needed to an average of 0.5 (p < 0.0001). Conclusion: Zileuton may help decrease the number of sinus surgeries needed in AERD.
AB - Background: Chronic rhinosinusitis (CRS) in the setting of Aspirin Exacerbated Respiratory Disease (AERD) have high rate of treatment failure and disease recurrence. Objective: Evaluate the long-term effect of zileuton on sinonasal outcomes in patients with AERD. Methods: AERD patients were reviewed and divided into two cohorts, depending if they were treated with zileuton during their clinical course. Demographic data, 22-item sinonasal outcome test (SNOT-22), Lund-Kennedy (LK) endoscopy score, duration of treatment, and number of sinus surgeries performed were collected. Results: 40 AERD patients were included, with follow-up duration up to 10 years (avg of 5.2 years). All patients were treated with topical saline and budesonide irrigations, intranasal steroid spray, and montelukast. 19 patients had uncontrolled sinus disease requiring multiple steroid tapers and were switched from montelukast to zileuton (cohort 1, 47.5%) at some point in their treatment. 21 patients (cohort 2, 52.5%) never needed zileuton. The average duration of treatment with zileuton was 6 years. Patients who required zileuton had a worse SNOT-22 (32.1 vs 19, p = 0.117), worse LK score (8.1 vs 7.5, p = 0.504), and higher average number of surgeries (1.9 vs 1.6, p = 0.343). The outcomes in the zileuton cohort trended toward improvement, however these did not reach statistical significance with an improved SNOT-22 from 32.1 to 27.4 (p = 0.617) and LK score from 7.9 to 6.2 (p = 0.092); The addition of zileuton significantly lowered the number of surgeries needed to an average of 0.5 (p < 0.0001). Conclusion: Zileuton may help decrease the number of sinus surgeries needed in AERD.
KW - AERD
KW - Chronic rhinosinusitis
KW - Nasal polyposis
KW - Outcome
KW - Zileuton
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U2 - 10.1016/j.amjoto.2021.103227
DO - 10.1016/j.amjoto.2021.103227
M3 - Article
C2 - 34563805
AN - SCOPUS:85115376635
SN - 0196-0709
VL - 43
JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
IS - 1
M1 - 103227
ER -