The safety and efficacy of aspirin desensitization combined with long-term aspirin therapy in Aspirin-exacerbated respiratory disease.

BACKGROUND: To assess the safety and efficacy of aspirin desensitization combined with long-term aspirin therapy in subjects with aspirin-exacerbated respiratory disease (AERD).

METHODS: We searched the PUBMED, Ovid and Cochrane Library from inception to October 2018, and we imposed a restriction of English on language of publication. Only randomized controlled trials, parallel or cross-over, were included in which adult subjects with AERD were randomly assigned to receive aspirin desensitization and long-term aspirin therapy or placebo.

RESULTS: A total of 869 citations were retrieved and 6 studies met the criteria for analysis. All studies indicated that either nasal symptoms, or asthma symptoms, or both improved significantly after aspirin desensitization treatment. And most studies indicated a decline of corticosteroid dosage，oral or inhaled. The four studies which documented nasal polyps did not demonstrate a change in nasal polyps with aspirin therapy compared to placebo. Dropout rates in all studies reviewed range from 5.8% to 55.7% and the most common adverse events were gastrointestinal symptoms.

CONCLUSIONS: Clearly, aspirin desensitization and treatment are beneficial for AERD patients, with a reduction of nasal symptoms, improvements in asthma control and decrease of daily corticosteroid use, without fatal adverse events. However, long-term side effects of aspirin desensitization and optimal dosage of aspirin merit further investigation.