伴鼻息肉的慢性鼻窦炎患者的医疗资源利用——Reg-ent临床数据登记分析

文献信息

中文摘要

背景： 对药物治疗失败的伴鼻息肉的慢性鼻窦炎（CRSwNP）患者，常提供内镜鼻窦手术（ESS）。度普利尤单抗也用于治疗控制不佳的CRSwNP患者。
目的： 本回顾性队列研究利用全国登记数据，考察CRSwNP患者的医疗资源利用模式。
方法： 对AAO-HNSF Reg-entSM数据登记中2019年至2025年接受ESS或接受度普利尤单抗治疗的CRSwNP患者进行回顾性分析。主要结局为无口服抗生素和无皮质类固醇的概率，采用Kaplan-Meier估计进行总结，并通过分段Cox比例风险模型比较度普利尤单抗治疗与手术，随访时间在6个月处分割，同时校正年龄、性别、族裔、种族、哮喘史和过敏性鼻炎。次要结局包括鼻息肉复发/持续存在和重复影像学检查。
结果： 共纳入12,944例患者。Kaplan-Meier分析显示风险比随时间变化，表明接受度普利尤单抗治疗的患者在早期干预后使用抗生素/皮质类固醇的相对风险较低，但该组的相对风险随时间增加。与ESS患者相比，度普利尤单抗治疗患者在最初6个月内抗生素/皮质类固醇使用较低（HR = 0.873；aHR = 0.740；p < 0.0001），但此后抗生素/皮质类固醇使用较高（HR = 1.60，aHR = 1.279；p < 0.0012）。度普利尤单抗组在两个时间段内鼻息肉复发/持续存在的风险均增加（6个月前后的aHR = 1.189和2.040，p < 0.0005和0.0001）。在最初6个月内，度普利尤单抗患者重复影像学检查的风险高于ESS患者（aHR = 2.098；p < 0.0001）。6个月后，度普利尤单抗患者的风险低于ESS患者（aHR = 0.409，p < 0.0001）。
结论： 接受度普利尤单抗和ESS治疗的CRSwNP患者随时间表现出不同的医疗资源利用，凸显了在考虑为CRSwNP启动度普利尤单抗治疗时患者选择和共同决策的重要性。

英文摘要

BackgroundPatients with chronic rhinosinusitis with nasal polyps (CRSwNP) who fail medical management are often offered endoscopic sinus surgery (ESS). Dupilumab is also used to treat patients with inadequately controlled CRSwNP.ObjectiveThis retrospective cohort study uses a national registry to examine the patterns in healthcare utilization in patients with CRSwNP.MethodsA review of the AAO-HNSF Reg-entSM data registry of CRSwNP patients who underwent ESS or received dupilumab from 2019 to 2025 was performed. The primary outcome of oral antibiotic and corticosteroid free-probability was summarized by Kaplan-Meier estimates and compared between dupilumab treatment and surgery by piecewise Cox proportional hazards model with follow-up time split at 6 months while adjusting for age, sex, ethnicity, race, history of asthma, and allergic rhinitis. Secondary outcomes include polyp recurrence/persistence and repeat imaging.Results12,944 patients were included. Kaplan-Meier analysis demonstrated the hazard ratio changing over time indicating lower relative hazard of post-intervention antibiotics/corticosteroid use early on among patients who were treated with dupilumab, but the relative hazard of the group increased over time. Antibiotic/corticosteroid use was lower among dupilumab treated patients compared to ESS patients (HR = 0.873; aHR = 0.740; p < 0.0001) in the first 6 months, but they demonstrated higher antibiotic/corticosteroid use thereafter (HR = 1.60, aHR = 1.279; p < 0.0012). There was an increased risk of nasal polyp recurrence/persistence in the dupilumab group during both time periods (aHR = 1.189 & 2.040 before and after 6 months, p < 0.0005 & 0.0001). During the first 6 months, the hazard of repeat imaging was higher among dupilumab patients compared to ESS patients (aHR = 2.098; p < 0.0001). After 6 months, the hazard among dupilumab patients was lower than the ESS patients (aHR = 0.409, p < 0.0001).ConclusionCRSwNP patients treated with dupilumab and ESS demonstrated variable healthcare utilization over time, highlighting the importance of patient selection and shared decision making when considering initiation of dupilumab therapy for CRSwNP.