Predictive factors for identifying macrolide responder in treating chronic rhinosinusitis

BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict responders. METHODOLOGY: A prospective cohort was performed. Patients CRS received roxithromycin (150 mg) once daily 12 weeks. Nasal secretions and serology were collected. Nine predictors response assessed: nasal secretion IgE, IL-5, serum eosinophils, neutrophils, polyps, asthma, allergy, aspirin hypersensitivity, using receiver-operating curve analysis multivariable logistic regression. Macrolide responders those sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased ≤5, no rescue medication. RESULTS: One hundred patients (mean age 47.4±14.1 years, 45% male) enrolled. Univariable regression showed local total IgE less than 5.21; eosinophils 2.2% associated macrolide response. Multivariate models maintained an independent association response, ability discriminate between non-responders of 63%. Serum neutrophil, polyp, hypersensitivity CONCLUSIONS: Low level the not serum,