title: Anti-IgE monoclonal antibody therapy for the treatment of chronic rhinosinusitis: a systematic review.
abstract: BACKGROUND
  Several options are available for the treatment of chronic rhinosinusitis (CRS), but disease control remains elusive for many patients. Recently, literature has emerged describing anti-IgE monoclonal antibody as a potential therapy for CRS. However, its effectiveness and safety are not well known. The purpose of this systematic review was to assess the effectiveness and safety of anti-IgE therapy and to identify evidence gaps that will guide future research for the management of CRS.
  
  
  METHODS
  Methodology was registered with PROSPERO (No. CRD42014007600). A comprehensive search was performed of standard bibliographic databases, Google Scholar, and clinical trials registries. Only randomized controlled trials assessing anti-IgE therapy in adult patients for the treatment of CRS were included. Two independent reviewers extracted data using a pre-defined extraction form and performed quality assessment using the Cochrane risk of bias tool and the GRADE framework.
  
  
  RESULTS
  Two studies met our inclusion criteria. When comparing anti-IgE therapy to placebo, there was a significant difference in Lund-McKay score (p = 0.04) while no difference was seen for percent opacification on computed tomography (CT). At 16 weeks, treatment led to a decrease in clinical polyp score. No significant difference was seen with regard to quality of life (Total Nasal Symptom Severity (TNSS), p < 0.21; Sinonasal Outcome Test 20 (SNOT-20), p < 0.60), and no serious complications were reported in either trial. Based on the quality assessment, studies were deemed to be of moderate risk of bias and a low overall quality of evidence.
  
  
  CONCLUSIONS
  There is currently insufficient evidence to determine the effectiveness of anti-IgE monoclonal antibody therapy for the treatment of CRS.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. jhong042@uottawa.ca.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Hong
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. tsang@uottawa.ca.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Tsang
authors.affiliation: Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada. jasongquinn@gmail.com.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Quinn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, 737 Parkdale Ave., Room 459, Ottawa, Ontario, K1Y 1J8, Canada. jamie.bonaparte@gmail.com.
authors.forename: James P
authors.initials: JP
authors.lastname: Bonaparte
authors.affiliation: Center for Practice Changing Research, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada. adstevens@ohri.ca.|Department of Clinical Epidemiology, University of Ottawa, Ottawa, ON, Canada. adstevens@ohri.ca.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Stevens
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, 737 Parkdale Ave., Room 459, Ottawa, Ontario, K1Y 1J8, Canada. kiltysj@gmail.com.
authors.forename: Shaun J
authors.initials: SJ
authors.lastname: Kilty
mesh_terms: D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012220:Rhinitis / Q000188:drug therapy* / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; C026408:anti-IgE antibodies