A Narrative Review of Recent Developments in Aspirin Therapy After Desensitization in NSAIDs-Exacerbated Respiratory Disease.

NSAID-exacerbated respiratory disease (N-ERD) is characterized by asthma, chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), and intolerance to NSAIDs (including aspirin). In N-ERD, CRSwNP often remains refractory to standard medical and surgical treatment, necessitating escalation. Aspirin therapy after desensitization (ATAD) is an established option for CRSwNP in N-ERD, but its use is limited by adverse effects, non-response, and safety issues associated with aspirin desensitization. This narrative review focuses on newer developments in ATAD for N-ERD, including shortened desensitization schedules, lower aspirin maintenance doses, and use of intranasal preparations of aspirin such as intranasal lysine-aspirin. The developments in use of biomarkers for distinguishing the different underlying endotypes and phenotypes of N-ERD, and subsequent potential for individualization of treatment are also discussed. The availability of biologics for the treatment of CRSwNP may provide further treatment escalation options in N-ERD patients who do not tolerate or respond to ATAD; however, there is an absence of direct comparative evidence for ATAD versus biologics. Further, the conjunctive use of ATAD and biologics provides an interesting avenue of research. Finally, following a discussion of the recent advancements in ATAD and biologics in N-ERD, clinical recommendations for treatment options and pathways are made.