Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease.
BACKGROUND
Aspirin desensitization followed by daily aspirin provides therapeutic benefits to patients with aspirin-exacerbated respiratory disease (AERD). It is not well understood how eicosanoid levels change during aspirin treatment.


OBJECTIVE
To investigate associations between clinical outcomes of aspirin treatment and plasma eicosanoid levels in patients with AERD.


METHODS
Thirty-nine patients with AERD were offered aspirin treatment (650 mg twice daily) for 4 weeks. Respiratory parameters and plasma levels of multiple eicosanoids were recorded at baseline and after 4 weeks of aspirin therapy using the Asthma Control Test and Rhinoconjunctivitis Quality of Life Questionnaire. Respiratory function was evaluated using the FEV1and nasal inspiratory peak flow.


RESULTS
After aspirin treatment, respiratory symptoms improved in 16 patients, worsened in 12 patients, and did not change in 4 patients. Seven patients were unable to complete the desensitization protocol. Patients with symptom improvement had higher baseline plasma 15-hydroxyeicosatetraenoic acid (15-HETE) levels than did patients with symptom worsening: 7006 pg/mL (interquartile range, 6056-8688 pg/mL) versus 4800 pg/mL (interquartile range, 4238-5575 pg/mL), P = .0005. Baseline 15-HETE plasma levels positively correlated with the change in Asthma Control Test score (r = 0.61; P = .001) and in FEV1after 4 weeks of aspirin treatment (r = 0.49; P = .01). It inversely correlated with Rhinoconjunctivitis Quality of Life Questionnaire score (r = -0.58; P = .002). Black and Latino patients were more likely to have symptom worsening on aspirin or fail to complete the initial desensitization than white, non-Latino patients (P = .02).


CONCLUSIONS
In patients with AERD, low baseline 15-HETE plasma levels and black or Latino ethnicity are associated with worsening of respiratory symptoms during aspirin treatment.
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY. Electronic address: Elina.Jerschow@einstein.yu.edu.
Elina
E
Jerschow
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
Matthew L
ML
Edin
Albert Einstein College of Medicine, Bronx, NY.
Teresa
T
Pelletier
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Waleed M
WM
Abuzeid
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Nadeem A
NA
Akbar
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Marc
M
Gibber
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Marvin
M
Fried
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
Fred B
FB
Lih
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
Artiom
A
Gruzdev
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
J Alyce
JA
Bradbury
Albert Einstein College of Medicine, Bronx, NY.
Weiguo
W
Han
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Golda
G
Hudes
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Taha
T
Keskin
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Victor L
VL
Schuster
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Simon
S
Spivack
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
Darryl C
DC
Zeldin
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
David
D
Rosenstreich
D000328:Adult; D001241:Aspirin / Q000627:therapeutic use*; D055963:Asthma, Aspirin-Induced / Q000097:blood* / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D044383:Black People; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D003888:Desensitization, Immunologic; D005260:Female; D005541:Forced Expiratory Volume; D006630:Hispanic or Latino; D006801:Humans; D006893:Hydroxyeicosatetraenoic Acids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D016861:Cyclooxygenase Inhibitors; D006893:Hydroxyeicosatetraenoic Acids; C025984:15-hydroxy-5,8,11,13-eicosatetraenoic acid; D001241:Aspirin
15-hydroxyeicosatetraenoic acid; Aspirin desensitization; Aspirin-exacerbated respiratory disease; Eicosanoids; Eosinophils