DYNAMICS OF CLINICAL SYMPTOMS UNDER THE INFLUENCE OF ENDOTYPE-ORIENTED PHARMACOTHERAPY OF CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS
Authors: Koshel I. V. , Maksymenko Ya. R. 
Published: October 2022

Chronic rhinosinusitis (CRS) is a clinical syndrome including several clinical phenotypes and endotypes with differences in pathophysiology. Chronic rhinosinusitis with nasal polyposis (NP) is the most severe CRS phenotype associated with treatment resistance and frequent recurrence after surgery. Among patients with CRS with NP, up to 96% have radiological changes that demonstrate damage to the paranasal sinuses and indicate a diffuse lesion. Pharmacotherapy based on endotyping using aminocapronic acid (ACA) competitively inhibits plasminogen and plasmin formation, inhibits C3a and C5a, which can affect the pathophysiological mechanisms of polypus growth, is promising.
The aim of the study: to evaluate the clinical effectiveness of the additional appointment of ACA in comparison with patients receiving standard therapy of CRS with NP according to clinical recommendations.
Material and methods. The study included 120 outpatients, divided into two groups: the main (n-60) and the control (n-60) ones. The main group (n-60) included 35 (58.3%) men and 25 (41.7%) women, the control group (n-60) included 32 (53.3%) men and 28 (46.7%) of women. The average age of the main group was 45.8 years; the control group was 47.0 years. Patients were prescribed basic treatment, but patients in the main group were additionally prescribed aminocapronic acid (ACA). The evaluation of the treatment effectiveness was based on the analysis of the dynamics of clinical symptoms: rhinorrhea, postnasal drip, nasal congestion, reduced sense of smell according to the SNOT 22 scale (from 0 to 5 points for each symptom) at V2 (5±1), V3 (10±1), V4 (20±1) and V5 (30±1) compared to V0, as well as the presence of indications for surgical treatment were determined at V3.
Results. The use of aminocapronic acid in CRS with NP contributes to a reliable reduction in the severity of the main clinical symptoms (rhinorrhea, postnasal drip, nasal congestion, reduced sense of smell) at V2 and V3 in comparison with patients of the control group. This provided a statistically significant difference at 25% in the reduction of operated patients: 56.7% in the main group versus 81.7% in the control group (p<0.05). Conservative treatment was continued for 43.3% of patients in the main group and for 18.3% of patients in the control group (p<0.05). Such a difference in the dynamic of symptoms regression can be explained by the peculiarities of the biological action of ACA, which can influence the pathophysiological features that characterize the endotype of diffuse eosinophilic CRS with NP. After the removal of the operated patients, the groups did not differ significantly differ in the dynamics of the regression of rhinorrhea, postnasal drip, nasal congestion, decreased sense of smell at V4 and V5 (p>0.05). Differences in the results of treatment are attributed to the clinical effects of ACA, since the group characteristics of the patients were commensurable.
Conclusions:

the use of ACA in addition to the basic therapy in patients suffering from CRS with NP contributes to a significant reduction in the severity of the main clinical symptoms in the first 10 days of treatment compared to patients in the control group;
the positive dynamics of clinical symptoms correlates with a reliable, at 25%, reduction in the number of surgical interventions.