medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-110medsovet-9104Research ArticleПРАКТИКАPRACTICEКлинико-морфологические параллели в лечении пациентов с полипозным риносинуситом и бронхиальной астмой методом биологической терапииClinical and morphological correlations in patients with chronic rhinosinusitis with nasal polyps and comorbid bronchial asthma during biologic therapyhttps://orcid.org/0000-0001-7341-1167СивохинД. А.SivokhinD. A.

Сивохин Дмитрий Алексеевич - аспирант кафедры болезней уха, горла и носа, Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Dmitrii A. Sivokhin - Postgraduate Student of the Department of Ear, Throat and Nose Diseases, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

dr.sivokhin@gmail.comhttps://orcid.org/0000-0001-7414-1293СвистушкинВ. М.SvistushkinV. M.

Свистушкин Валерий Михайлович - д.м.н., профессор, директор клиники болезней уха, горла и носа Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Valery M. Svistushkin - Dr. Sci. (Med.), Professor, Head of the Department of Ear, Throat and Nose Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

svvm3@yandex.ruhttps://orcid.org/0000-0003-4755-0205ЩенниковаЕ. С.ShchennikovaE. S.

Щенникова Екатерина Сергеевна - врач-оториноларинголог отделения оториноларингологии Университетской клинической больницы №1.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Ekaterina S. Shchennikova - Otorhinolaryngologist, Department of Otorhinolaryngology, University Clinical Hospital No. 1, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

katt-she@yandex.ruhttps://orcid.org/0000-0001-9704-5915АвраамоваС. Т.AvraamovaS. T.

Авраамова София Тариэловна - к.м.н., доцент Института клинической морфологии и цифровой патологии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Sofya T. Avraamova - Cand. Sci. (Med.), Associate Professor at the Institute of Clinical Morphology and Digital Pathology, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

avraamovast@mail.ruhttps://orcid.org/0009-0005-1365-1720АлександровП. С.AleksandrovP. S.

Александров Петр Сергеевич - ассистент Института клинической морфологии и цифровой патологии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Petr S. Aleksandrov - Assistant at the Institute of Clinical Morphology and Digital Pathology, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

aleksandrov_p_s@staff.sechenov.ruhttps://orcid.org/0000-0002-6946-6146ДемураТ. А.DemuraT. A.

Демура Татьяна Александровна - д.м.н., профессор, директор Института клинической морфологии и цифровой патологии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Tatiana A. Demura - Dr. Sci. (Med.), Professor, Director, Institute of Clinical Morphology and Digital Pathology, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

demura_t_a@staff.sechenov.ruhttps://orcid.org/0000-0002-1562-6386КняжескаяН. П.KnyazheskayaN. P.

Княжеская Надежда Павловна - к.м.н., доцент кафедры пульмонологии.

117997, Москва, ул. Островитянова, д. 1

Nadezhda P. Knyazheskaya - Cand. Sci. (Med.), Associate Professor of the Department of Pulmonology, Pirogov Russian National Research Medical University.

1, Ostrovityanov St., Moscow, 117997

kniajeskaia@mail.ruhttps://orcid.org/0000-0002-5895-2982КамелеваА. А.KamelevaA. A.

Камелева Анастасия Андреевна - к.м.н., врач – аллерголог-иммунолог отделения респираторной медицины, ГКБ им. С.С. Юдина; ассистент кафедры клинической иммунологии, аллергологии и адаптологии факультета непрерывного медицинского образования, РУДН им. Патриса Лумумбы.

105077, Москва, Коломенский проезд, д. 4; 117198, Москва, ул. Миклухо-Маклая, д. 6

Anastasia A. Kameleva - Cand. Sci. (Med.), Allergist-Immunologist at the Respiratory Medicine Department, Yudin City Clinical Hospital; Assistant of the Department of Clinical Immunology, Allergy, and Adaptation of the Faculty of Continuous Medical Education of the Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba.

4, Kolomenskiy Proezd, Moscow, 105077; 6, Miklukho-Maklai St., Moscow, 117198

yurenkova@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница имени С.С. Юдина; Российский университет дружбы народов имени Патриса ЛумумбыРоссияYudin City Clinical Hospital; Peoples’ Friendship University of Russia named after Patrice LumumbaRussian Federation20252405202507191198Copyright © Сивохин Д.А., Свистушкин В.М., Щенникова Е.С., Авраамова С.Т., Александров П.С., Демура Т.А., Княжеская Н.П., Камелева А.А., 20252025Сивохин Д.А., Свистушкин В.М., Щенникова Е.С., Авраамова С.Т., Александров П.С., Демура Т.А., Княжеская Н.П., Камелева А.А.Sivokhin D.A., Svistushkin V.M., Shchennikova E.S., Avraamova S.T., Aleksandrov P.S., Demura T.A., Knyazheskaya N.P., Kameleva A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9104Введение

Введение. Биологическая терапия, используемая для лечения полипозного риносинусита (ПРС), значительно снижает выраженность симптомов, однако ее эффективность может зависеть от гистологического типа полипов.

Цель

Цель. Оценить влияние типа назальных полипов на эффективность биологической терапии препаратом дупилумаб у пациентов с полипозным риносинуситом и сопутствующей бронхиальной астмой.

Материалы и методы

Материалы и методы. В когортном наблюдательном исследовании пациенты, у которых предшествующее хирургическое и медикаментозное лечение оказалось недостаточно эффективным, были разделены на группы по типу полипов (отечные, эозинофильные, фиброзные) и получали дупилумаб (300 мг подкожно каждые две недели) в течение 52 нед. Оценка на различных временных точках проводилась по шкале Nasal Polyp Score (NPS) и шкале Лунда – Маккея.

Результаты и обсуждение

Результаты и обсуждение. Пациенты с отечными полипами продемонстрировали наибольшее улучшение по шкале Лунда – Маккея (снижение среднего балла с 20,94 ± 3,36 до 5,44 ± 3,22 к 52-й нед. лечения (p < 0,001), с наиболее выраженным снижением в первые 16 нед. (до 6,38 ± 3,05). У пациентов с эозинофильным и фиброзным типом полипов отмечалось меньшее уменьшение – с 20,87 ± 2,74 до 7,17 ± 4,15 баллов и с 20,86 ± 2,32 до 10,29 ± 3,24 соответственно. По шкале NPS у пациентов с отечными полипами средний балл снизился с 6,81 ± 0,83 до 2,00 ± 1,15, у пациентов с эозинофильными полипами – с 6,96 ± 0,93 до 2,65 ± 1,94, а у пациентов с фиброзными полипами – с 6,43 ± 0,85 до 2,50 ± 0,94 к 52-й нед.

Выводы

Выводы. Отечный тип полипа ассоциируется с наиболее выраженным ответом на биологическую терапию, в то время как фиброзные полипы демонстрируют менее выраженную динамику.

Introduction

Introduction. Biologic therapy used for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) effectively reduces symptom severity; however, its efficacy may depend on the histological type of polyps. The aim of this study was to assess the impact of nasal polyp type on the effectiveness of dupilumab in patients with CRSwNP and comorbid asthma.

Materials and methods

Materials and methods. This cohort observational study included patients in whom previous surgical and pharmacological treatments had proven insufficient. Participants were categorized into three groups based on polyp histology (edematous, eosinophilic, fibrotic) and received dupilumab (300 mg subcutaneously every two weeks) for 52 weeks. Treatment efficacy was assessed at predefined time points using the Nasal Polyp Score (NPS) and the Lund-Mackay scale.

Results

Results. Patients with edematous polyps exhibited the most pronounced improvement on the Lund-Mackay scale, with a mean reduction from 20.94 ± 3.36 to 5.44 ± 3.22 by week 52 (p < 0.001). In contrast, eosinophilic and fibrotic polyps showed less pronounced reductions, from 20.87 ± 2.74 to 7.17 ± 4.15 and from 20.86 ± 2.32 to 10.29 ± 3.24, respectively. Similarly, NPS scores decreased from 6.81 ± 0.83 to 2.00 ± 1.15 in edematous polyps, from 6.96 ± 0.93 to 2.65 ± 1.94 in eosinophilic polyps, and from 6.43 ± 0.85 to 2.50 ± 0.94 in fibrotic polyps by week 52.

Conclusions

Conclusions. The edematous polyp type is associated with the most pronounced response to biologic therapy, whereas fibrotic polyps demonstrate a less significant reduction in size.

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The authors declare that there are no conflicts of interest present.