Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis
Background Aspirin desensitization is increasingly recommended for the treatment of aspirin‐exacerbated respiratory disease (AERD). The objective of this study is to systematically review the efficacy and safety of aspirin desensitization in patients with AERD. Methods We searched MEDLINE, EMBASE, t...
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| Veröffentlicht in: | International forum of allergy & rhinology 2019-12, Vol.9 (12), p.1409-1419 |
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| creator | Chu, Derek K. Lee, Daniel J. Lee, Keith M. Schünemann, Holger J. Szczeklik, Wojciech Lee, John M. |
| description | Background
Aspirin desensitization is increasingly recommended for the treatment of aspirin‐exacerbated respiratory disease (AERD). The objective of this study is to systematically review the efficacy and safety of aspirin desensitization in patients with AERD.
Methods
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception to January 5, 2019. We included randomized trials and comparative observational studies in any language. Data extraction and risk of bias assessment were performed in duplicate independently.
Results
Five randomized controlled trials (RCTs) enrolled 233 patients with AERD. Compared to placebo, aspirin desensitization (mean daily dose 800 mg) improved quality of life (risk ratio [RR] 2.00; 95% confidence interval [CI], 1.31 to 3.06; heterogeneity measure [I2] = 0%; risk difference [RD] +24%; 22‐item Sino‐Nasal Outcome Test [SNOT‐22] scale [0 to 110, higher worse]; mean difference [MD] −10.27 [95% CI, −6.39 to −14.15]; moderate‐certainty); and respiratory symptoms (RR 2.20 [95% CI, 1.55 to 2.73], I2 = 34%, RD +36%; American Academy of Otolaryngology (AAO) scale [0 to 20, higher worse]; MD −2.56 [95% CI,−1.12 to −3.92]; high‐certainty). Aspirin desensitization increased adverse events severe enough to cause treatment discontinuation (major bleeding, gastritis, asthma exacerbation, or rash causing drug discontinuation, RR 4.39 [95% CI, 1.43 to 13.50], I2 = 0%, RD +11%, moderate‐certainty), and gastritis (RR 3.84 [95% CI, 1.12 to 13.19], I2 = 0%, RD +9%, low‐certainty). Findings were robust to sensitivity analyses. Two available observational studies were not informative because they lacked adjustment for confounders and/or contemporaneous controls.
Conclusion
In patients with AERD, moderate‐certainty and high‐certainty evidence shows that aspirin desensitization meaningfully reduces symptoms of rhinosinusitis and improves quality of life, but results in a significant increase in adverse events. |
| doi_str_mv | 10.1002/alr.22428 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2290888304</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2322662565</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-ea1f4ea00f2f8b7852a1a07fa2d4fd215a598418a1489129d4743ee198e55e653</originalsourceid><addsrcrecordid>eNp1kc1KLDEQRoMoKurCF5CAG12MJumkO-1ORa_CgCC6bmq6KxjpnzHVo7YrFz6Az-iT3DijLgSzSUhOnVTxMbYtxYEUQh1CHQ6U0sousXUltBqludXLP-csXWNbRPciLiONkdkqW0ukkVak-Tp7O8EWne-JQ1vxOwgN8c5xoKkPvuUVErbke_8Cve9a7rrw_fbx-o7PUGKYQI8VD_h5DX0XBl55QiA84sBpoB6bWFxG4tHj0_yfBnuI9dBCPZCnTbbioCbc-to32O352c3pxWh89e_y9Hg8KhOT2BGCdBpBCKecnWTWKJAgMgeq0q5S0oCJo0sLUttcqrzSmU4QZW7RGExNssH2Ft5p6B5mSH3ReCqxrqHFbkaFUrmw1iZCR3T3F3rfzULsN1KJUmmqzFy4v6DK0BEFdMU0-AbCUEhRfKZTxHSKeTqR3fkyziYNVj_kdxYROFwAT77G4W9TcTy-Xij_AzgdnFk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2322662565</pqid></control><display><type>article</type><title>Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Chu, Derek K. ; Lee, Daniel J. ; Lee, Keith M. ; Schünemann, Holger J. ; Szczeklik, Wojciech ; Lee, John M.</creator><creatorcontrib>Chu, Derek K. ; Lee, Daniel J. ; Lee, Keith M. ; Schünemann, Holger J. ; Szczeklik, Wojciech ; Lee, John M.</creatorcontrib><description>Background
Aspirin desensitization is increasingly recommended for the treatment of aspirin‐exacerbated respiratory disease (AERD). The objective of this study is to systematically review the efficacy and safety of aspirin desensitization in patients with AERD.
Methods
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception to January 5, 2019. We included randomized trials and comparative observational studies in any language. Data extraction and risk of bias assessment were performed in duplicate independently.
Results
Five randomized controlled trials (RCTs) enrolled 233 patients with AERD. Compared to placebo, aspirin desensitization (mean daily dose 800 mg) improved quality of life (risk ratio [RR] 2.00; 95% confidence interval [CI], 1.31 to 3.06; heterogeneity measure [I2] = 0%; risk difference [RD] +24%; 22‐item Sino‐Nasal Outcome Test [SNOT‐22] scale [0 to 110, higher worse]; mean difference [MD] −10.27 [95% CI, −6.39 to −14.15]; moderate‐certainty); and respiratory symptoms (RR 2.20 [95% CI, 1.55 to 2.73], I2 = 34%, RD +36%; American Academy of Otolaryngology (AAO) scale [0 to 20, higher worse]; MD −2.56 [95% CI,−1.12 to −3.92]; high‐certainty). Aspirin desensitization increased adverse events severe enough to cause treatment discontinuation (major bleeding, gastritis, asthma exacerbation, or rash causing drug discontinuation, RR 4.39 [95% CI, 1.43 to 13.50], I2 = 0%, RD +11%, moderate‐certainty), and gastritis (RR 3.84 [95% CI, 1.12 to 13.19], I2 = 0%, RD +9%, low‐certainty). Findings were robust to sensitivity analyses. Two available observational studies were not informative because they lacked adjustment for confounders and/or contemporaneous controls.
Conclusion
In patients with AERD, moderate‐certainty and high‐certainty evidence shows that aspirin desensitization meaningfully reduces symptoms of rhinosinusitis and improves quality of life, but results in a significant increase in adverse events.</description><identifier>ISSN: 2042-6976</identifier><identifier>EISSN: 2042-6984</identifier><identifier>DOI: 10.1002/alr.22428</identifier><identifier>PMID: 31518069</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>AERD ; Aspirin ; aspirin‐induced asthma ; Asthma ; Clinical trials ; Gastritis ; Meta-analysis ; NSAIDs ; Patients ; Quality of life ; Respiratory diseases ; Rhinosinusitis ; Sensitivity analysis ; sinusitis ; systematic review</subject><ispartof>International forum of allergy & rhinology, 2019-12, Vol.9 (12), p.1409-1419</ispartof><rights>2019 ARS‐AAOA, LLC</rights><rights>2019 ARS-AAOA, LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-ea1f4ea00f2f8b7852a1a07fa2d4fd215a598418a1489129d4743ee198e55e653</citedby><cites>FETCH-LOGICAL-c3538-ea1f4ea00f2f8b7852a1a07fa2d4fd215a598418a1489129d4743ee198e55e653</cites><orcidid>0000-0003-4057-2858 ; 0000-0001-8269-4496</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Falr.22428$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Falr.22428$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31518069$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chu, Derek K.</creatorcontrib><creatorcontrib>Lee, Daniel J.</creatorcontrib><creatorcontrib>Lee, Keith M.</creatorcontrib><creatorcontrib>Schünemann, Holger J.</creatorcontrib><creatorcontrib>Szczeklik, Wojciech</creatorcontrib><creatorcontrib>Lee, John M.</creatorcontrib><title>Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis</title><title>International forum of allergy & rhinology</title><addtitle>Int Forum Allergy Rhinol</addtitle><description>Background
Aspirin desensitization is increasingly recommended for the treatment of aspirin‐exacerbated respiratory disease (AERD). The objective of this study is to systematically review the efficacy and safety of aspirin desensitization in patients with AERD.
Methods
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception to January 5, 2019. We included randomized trials and comparative observational studies in any language. Data extraction and risk of bias assessment were performed in duplicate independently.
Results
Five randomized controlled trials (RCTs) enrolled 233 patients with AERD. Compared to placebo, aspirin desensitization (mean daily dose 800 mg) improved quality of life (risk ratio [RR] 2.00; 95% confidence interval [CI], 1.31 to 3.06; heterogeneity measure [I2] = 0%; risk difference [RD] +24%; 22‐item Sino‐Nasal Outcome Test [SNOT‐22] scale [0 to 110, higher worse]; mean difference [MD] −10.27 [95% CI, −6.39 to −14.15]; moderate‐certainty); and respiratory symptoms (RR 2.20 [95% CI, 1.55 to 2.73], I2 = 34%, RD +36%; American Academy of Otolaryngology (AAO) scale [0 to 20, higher worse]; MD −2.56 [95% CI,−1.12 to −3.92]; high‐certainty). Aspirin desensitization increased adverse events severe enough to cause treatment discontinuation (major bleeding, gastritis, asthma exacerbation, or rash causing drug discontinuation, RR 4.39 [95% CI, 1.43 to 13.50], I2 = 0%, RD +11%, moderate‐certainty), and gastritis (RR 3.84 [95% CI, 1.12 to 13.19], I2 = 0%, RD +9%, low‐certainty). Findings were robust to sensitivity analyses. Two available observational studies were not informative because they lacked adjustment for confounders and/or contemporaneous controls.
Conclusion
In patients with AERD, moderate‐certainty and high‐certainty evidence shows that aspirin desensitization meaningfully reduces symptoms of rhinosinusitis and improves quality of life, but results in a significant increase in adverse events.</description><subject>AERD</subject><subject>Aspirin</subject><subject>aspirin‐induced asthma</subject><subject>Asthma</subject><subject>Clinical trials</subject><subject>Gastritis</subject><subject>Meta-analysis</subject><subject>NSAIDs</subject><subject>Patients</subject><subject>Quality of life</subject><subject>Respiratory diseases</subject><subject>Rhinosinusitis</subject><subject>Sensitivity analysis</subject><subject>sinusitis</subject><subject>systematic review</subject><issn>2042-6976</issn><issn>2042-6984</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kc1KLDEQRoMoKurCF5CAG12MJumkO-1ORa_CgCC6bmq6KxjpnzHVo7YrFz6Az-iT3DijLgSzSUhOnVTxMbYtxYEUQh1CHQ6U0sousXUltBqludXLP-csXWNbRPciLiONkdkqW0ukkVak-Tp7O8EWne-JQ1vxOwgN8c5xoKkPvuUVErbke_8Cve9a7rrw_fbx-o7PUGKYQI8VD_h5DX0XBl55QiA84sBpoB6bWFxG4tHj0_yfBnuI9dBCPZCnTbbioCbc-to32O352c3pxWh89e_y9Hg8KhOT2BGCdBpBCKecnWTWKJAgMgeq0q5S0oCJo0sLUttcqrzSmU4QZW7RGExNssH2Ft5p6B5mSH3ReCqxrqHFbkaFUrmw1iZCR3T3F3rfzULsN1KJUmmqzFy4v6DK0BEFdMU0-AbCUEhRfKZTxHSKeTqR3fkyziYNVj_kdxYROFwAT77G4W9TcTy-Xij_AzgdnFk</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Chu, Derek K.</creator><creator>Lee, Daniel J.</creator><creator>Lee, Keith M.</creator><creator>Schünemann, Holger J.</creator><creator>Szczeklik, Wojciech</creator><creator>Lee, John M.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4057-2858</orcidid><orcidid>https://orcid.org/0000-0001-8269-4496</orcidid></search><sort><creationdate>201912</creationdate><title>Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis</title><author>Chu, Derek K. ; Lee, Daniel J. ; Lee, Keith M. ; Schünemann, Holger J. ; Szczeklik, Wojciech ; Lee, John M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-ea1f4ea00f2f8b7852a1a07fa2d4fd215a598418a1489129d4743ee198e55e653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>AERD</topic><topic>Aspirin</topic><topic>aspirin‐induced asthma</topic><topic>Asthma</topic><topic>Clinical trials</topic><topic>Gastritis</topic><topic>Meta-analysis</topic><topic>NSAIDs</topic><topic>Patients</topic><topic>Quality of life</topic><topic>Respiratory diseases</topic><topic>Rhinosinusitis</topic><topic>Sensitivity analysis</topic><topic>sinusitis</topic><topic>systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chu, Derek K.</creatorcontrib><creatorcontrib>Lee, Daniel J.</creatorcontrib><creatorcontrib>Lee, Keith M.</creatorcontrib><creatorcontrib>Schünemann, Holger J.</creatorcontrib><creatorcontrib>Szczeklik, Wojciech</creatorcontrib><creatorcontrib>Lee, John M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International forum of allergy & rhinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chu, Derek K.</au><au>Lee, Daniel J.</au><au>Lee, Keith M.</au><au>Schünemann, Holger J.</au><au>Szczeklik, Wojciech</au><au>Lee, John M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis</atitle><jtitle>International forum of allergy & rhinology</jtitle><addtitle>Int Forum Allergy Rhinol</addtitle><date>2019-12</date><risdate>2019</risdate><volume>9</volume><issue>12</issue><spage>1409</spage><epage>1419</epage><pages>1409-1419</pages><issn>2042-6976</issn><eissn>2042-6984</eissn><abstract>Background
Aspirin desensitization is increasingly recommended for the treatment of aspirin‐exacerbated respiratory disease (AERD). The objective of this study is to systematically review the efficacy and safety of aspirin desensitization in patients with AERD.
Methods
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception to January 5, 2019. We included randomized trials and comparative observational studies in any language. Data extraction and risk of bias assessment were performed in duplicate independently.
Results
Five randomized controlled trials (RCTs) enrolled 233 patients with AERD. Compared to placebo, aspirin desensitization (mean daily dose 800 mg) improved quality of life (risk ratio [RR] 2.00; 95% confidence interval [CI], 1.31 to 3.06; heterogeneity measure [I2] = 0%; risk difference [RD] +24%; 22‐item Sino‐Nasal Outcome Test [SNOT‐22] scale [0 to 110, higher worse]; mean difference [MD] −10.27 [95% CI, −6.39 to −14.15]; moderate‐certainty); and respiratory symptoms (RR 2.20 [95% CI, 1.55 to 2.73], I2 = 34%, RD +36%; American Academy of Otolaryngology (AAO) scale [0 to 20, higher worse]; MD −2.56 [95% CI,−1.12 to −3.92]; high‐certainty). Aspirin desensitization increased adverse events severe enough to cause treatment discontinuation (major bleeding, gastritis, asthma exacerbation, or rash causing drug discontinuation, RR 4.39 [95% CI, 1.43 to 13.50], I2 = 0%, RD +11%, moderate‐certainty), and gastritis (RR 3.84 [95% CI, 1.12 to 13.19], I2 = 0%, RD +9%, low‐certainty). Findings were robust to sensitivity analyses. Two available observational studies were not informative because they lacked adjustment for confounders and/or contemporaneous controls.
Conclusion
In patients with AERD, moderate‐certainty and high‐certainty evidence shows that aspirin desensitization meaningfully reduces symptoms of rhinosinusitis and improves quality of life, but results in a significant increase in adverse events.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31518069</pmid><doi>10.1002/alr.22428</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4057-2858</orcidid><orcidid>https://orcid.org/0000-0001-8269-4496</orcidid></addata></record> |
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| subjects | AERD Aspirin aspirin‐induced asthma Asthma Clinical trials Gastritis Meta-analysis NSAIDs Patients Quality of life Respiratory diseases Rhinosinusitis Sensitivity analysis sinusitis systematic review |
| title | Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis |
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