Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica

Abstract

Introduction: The Eosinophilic Nasal Polyposis (ENP) is a chronic inflammatory disease characterized by the formation of benign, multiple and bilateral nasal polyps. ENP has a multifactorial pathogenesis, being always associated with chronic inflammation. It is a benign disease, but with severe impairment lifes quality of patients. The treatments (corticosteroids and nasal endoscopic surgery) lead to control symptoms, but relapses are frequent. Macrolides used as immunomodulators are a promising tool for more effective disease control. Objectives: The evaluation of the treatment with low-dose long term azithromycin in ENP was based on subjective patient assessment, staging polyposis and quality of life questionnaire (SNOT-22). To characterize the inflammatory behavior and the percentage of eosinophils, before and after treatment, in biopsies of eosinophilic nasal polyps through score and correlate clinical improvement in patients with the histomorphological change. Patients and Methods: It's self-matched study of series in patients with ENP. Comparison of pretreatment and post-treatment with Azithromycin at a dose of 500 mg, orally, three times per week for 8 weeks were evaluated. Patients underwent clinical examination, staging, application of SNOT-22 and biopsy of nasal polyps at the beginning and the end of treatment. Results: Thirty-three patients completed the study. The medication was well tolerated overall. After treatment, was observed significant clinical improvement: subjective assessment of the patient (60.6%), staging of polyps (69.7%) and SNOT-22 (57.6%). We don`t found significant change in the inflammatory pattern, in the percentage or absolute number of eosinophils per field, in the samples before and after treatment (p> 0.05). There was no difference between the responses of the groups with and without asthma/aspirin intolerance. Patients that have an advanced stage in de beginning of the study showed less subjective improvement and reduced staging. Conclusion: Azithromycin, based on the study, could be considered a therapeutic option for ENP. More studies are needed to define the real mechanism of action involved.