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Longitudinal evaluation of SNOT-22 can distinguish patients with chronic rhinosinusitis with nasal polyps who respond quickly to monoclonal antibodies.

“[The Sino-Nasal Outcome Test 22 (SNOT-22)] is a questionnaire constituted by 22 items that generates a total score that is a measure of [health-related quality of life (HRQOL)] of patients suffering from [chronic rhinosinusitis (CRS)] with or without [nasal polyps (NP)], covering a series of symptoms that include physical problems, functional limitations, and emotional consequences,” researchers wrote in the World Allergy Organization Journal. “However, the SNOT-22 has expanded beyond its initial purpose of evaluating CRS therapy to become a widely used and clinically significant outcomes evaluation tool. SNOT-22 has become the standard questionnaire for measuring HRQOL of CRS in clinical trials; it has the advantage of considering both sinonasal and general health-related symptoms.”

Stefano Del Giacco, MD, PhD, and colleagues applied the SNOT-22 to patients with chronic rhinosinusitis with nasal polyps (CRSwNP) to compare scores before and after treatment with biologics. Assessments were done at 1 month, 6 months, and 12 months.

The study enrolled 59 patients diagnosed with CRSwNP (median age, 59 years). The treatment regimens for these participants were split accordingly: 9 received anti-IgE,19 received anti-IL5/5R, and 30 received anti-IL13/4R.

Treatment Cohorts

 In the cohort of patients treated with anti-IgE mAb, researchers noted a significant reduction in SNOT-22 score (P=0.02) between baseline and the first month of treatment, however, between baseline and 6 months and baseline and 12 months, the change in SNOT-22 score was not significant. Reduction in SNOT-22 scores was also insignificant when compared between the first month and the sixth month (P=0.41), between the first month and the 12^th month (P=0.7), and between the sixth month and the 12^th month (P=0.1).

Among patients treated with anti-IL5/ 5R, a significant reduction of SNOT-22 scores was noted between baseline and the first month (P=0.001) and between baseline and the sixth month (P=0.007). A comparison between the SNOT-22 scores obtained at baseline and the 12th month did not show a significant reduction (P=0.052). The same was true when scores from the first and sixth months were compared.

In the cohort of patients treated with anti-IL13/4R, statistically significant differences in SNOT-22 scores were noted between baseline and the first month (P<0.001), baseline and the sixth month (P<0.001), and baseline and the 12^th month (P<0.001)

Domain Variations

 The researchers applied SNOT-22 according to the following domains: nasal physiology, otologic, sleep, and emotional wellness. Regarding the participants in the anti-IgE treatment cohort, a significant reduction in SNOT-22 score was noted between baseline and the 12th month (P=0.03) in the emotional domain. No other significant reduction in score was observed.

Among patients treated with anti-IL5/5R mAbs, a significant change in SNOT-22 scores regarding the nasal domain was noted between baseline and the first month (P=0.0009), baseline and the sixth month (P=0.007), and baseline and the 12^th month (P=0.04). When focused on the otologic domain, a significant difference between SNOT-22 scores was noted between baseline and the first month (P=0.003), and between baseline and the sixth month (P=0.03). When focused on the emotional domain, a significant reduction in score was noted between baseline and the 12^th month (P=0.01).

For patients treated with anti-IL13/4R mAb, the researchers noted a significant reduction of SNOT-22 score in the nasal domain between baseline and the first month (P< 0.001), baseline and the sixth month (P< 0.001), and baseline and the 12^th month (P< 0.001). In terms of the otologic domain, a significant reduction in SNOT-22 scores was observed between baseline and the first month (P< 0.001), baseline and the sixth month (P=0.002), and baseline and the 12^th month (P=0.03). As for the sleep domain, patients in this treatment cohort had a significant reduction in scores between baseline and the first month (P<0.001), baseline and the sixth month (P< 0.001), and baseline and the 12^th month (P<0.001). A similar reduction in scores pertaining to the emotional wellness domain was also noted.

“The longitudinal evaluation of SNOT-22 can aid in promptly distinguishing patients who respond quickly to [monoclonal antibodies] from those who have a low or no response,” the researchers wrote. “It will probably also help in the near future in accurately defining clinical remission induced by targeted treatments.”