Résumé
Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) is a distinct phenotype of severe asthma associated with significant morbidity and, in some cases, mortality. It is characterized by hypersensitivity to COX-1-inhibiting NSAIDs, which limits access to anti-inflammatory treatments, significantly affecting quality of life and therapeutic options. Biologic therapies represent a promising alternative for managing NERD, but their role in ensuring the safety of NSAID drug provocation tests (DPTs) remains poorly studied.
To evaluate the safety and efficacy of COX-2 NSAID DPTs in NERD patients and to analyze their clinical characteristics based on the use or non-use of biologic therapies.
This prospective observational study (June 2024–January 2025) included 15 moderate to severe asthmatic patients, controlled, who had experienced bronchospasms with at least two chemically distinct COX-1 NSAIDs. Patients underwent an alternative DPTs with celecoxib (n=12) or piroxicam (n=3) and were stratified into two groups: those receiving biologic therapy (n=8) and those not receiving biologic therapy (n=7). The diagnosis of NERD was based on clinical history and, in doubtful cases, aspirin provocation tests.
Among the 15 patients (53% female, mean age: 50±16.7 years), ibuprofen was the most frequently implicated COX-1 NSAID (n=11, 73%). Biologic therapies included dupilumab (n=7, 46%) and omalizumab (n=1, 6%). Frequent comorbidities included eosinophilia>300μg/mL (n=13, 86%), nasal polyposis (n=9, 60%), allergic rhinitis (n=9, 60%), atopic dermatitis (n=4, 26%), and food hypersensitivity (n=4, 26%). All DPTs were well tolerated, with no post-DPT FEV1 reductions>20% (mean post-DPT FEV1: 3.15L). There was no significant difference in clinical characteristics, tolerance, or safety between the two groups (P>0.05).
COX-2 NSAID DPTs are safe and well tolerated, including in patients receiving biologic therapies. This strategy provides an effective therapeutic option for NERD patients with complex comorbidities while improving their quality of life.