Long-term Low-Dose Doxycycline for Difficult-to-Treat Chronic Rhinosinusitis with Polyps

Abstract

Objectives:

Assess the clinical outcome of long-term low-dose oral doxycycline in difficult-to-treat chronic rhinosinusitis with polyps.

Methods:

We conducted an open label prospective study in a university-based tertiary care center from 2013 to 2014 with 60 patients with difficult-to-treat chronic rhinosinusitis with nasal polyps uncontrolled after 6 or more months of endoscopic sinus surgery. They were divided into 2 groups: 28 patients received nasal steroids plus doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks while 32 patients received only nasal steroids. The main outcome measure was a meaningful improvement in SNOT-20 (>0.80). Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, DREA and blood testing before treatment for IgG, IgA, IgE, IgM, antineutrophil cytoplasmic antibodies, and blood eosinophil count.

Results:

There was a statistically significant association among meaningful improvement in SNOT-20 and doxycycline treatment [50.0% (14/28) vs 9.4% (3/32), P = .01]. The patients who received doxycycline also showed a statistically significant outcome in SNOT-20 (P = .002), NOSE (P = .046), and Lund-Kennedy (P = .004). The group who presented a clinically significant improvement of SNOT-20 also presented better outcomes on SNOT-20 and NOSE scores (P = .001),and almost statistically significant on Lund-Kennedy (P = .07). The presence of asthma (P = .006), aspirin-exacerbated respiratory disease (AERD; P = .018), and raised serum IgE (P < .035) were associated with a worse prognosis after treatment.

Conclusions:

These findings suggest that doxycycline may have a beneficial role in chronic rhinosinusits with polyps, particularly in patients without high levels of IgE, asthma, and AERD.