Macrolides
Macrolides exhibit immunomodulatory as well as antibiotic properties and
some mixed evidence exists to support long-term use in selected CRS
patients 112,113. The presumed mechanism of action is
the suppression of pro-inflammatory cytokines 118-120Two randomized, placebo-controlled trials have been performed in CRS.121,122 Post-hoc analysis of treatment response
indicated that patients with low serum IgE (and presumably non T2)
responded best and these responders exhibited decreased IL-8 levels in
the mucus post treatment 121. Later cohort studies
demonstrated a lack of efficacy for macrolides in eosinophilic CRSwNP
patients 123,124. It remains to be established whether
responders exhibit T1, T3, null or mixed endotypes. Studies of whether
macrolides might have an additive effect with other medications (e.g.
corticosteroids or a biologic) dedicated to suppressing T2 inflammation
are worth pursuing 125-127.