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October 8, 2020

Chronic Rhinosinusitis With Nasal Polyps In Patients With Aspirin Sensitivity—Mycophenolate Mofetil as an Effective Steroid-Sparing Agent

Author Affiliations
  • 1Rhinology Section, Royal National ENT Hospital, London, United Kingdom
  • 2University College London Hospital NHS Foundation Trust,, London, United Kingdom
  • 3University College London, London, United Kingdom
JAMA Otolaryngol Head Neck Surg. 2021;147(2):214-215. doi:10.1001/jamaoto.2020.3401

The therapeutic response of the more severe forms of chronic rhinosinusitis with nasal polyposis (CRSwNP) to biologics has not been fully evaluated, and therefore, anti-inflammatory therapy with oral steroids may still be required. Long-term treatment with systemic steroids can lead to significant comorbidity,1 yet steroid-sparing agents (SSAs) are rarely considered in the context of CRSwNP.2 Mycophenolate mofetil (MMF) is a potent immunosuppressant. Mycophenolate mofetil selectively inhibits T- and B-cell activation, proliferation, and effector function leading to an immunosuppressive state.3,4 Given the key role for T and B cells in CRSwNP in the drive and maintenance of T2 inflammation and immunoglobulin E production, we hypothesized that MMF should attenuate inflammation and allow reduction of the maintenance dose of systemic steroids.