Rhinosinusitis in Adults Receiving Tumor Necrosis Factor Alpha Inhibitors and Anti‐CD20 Therapy: A Scoping Review
Abstract
ABSTRACT Introduction Immunomodulatory therapies, including tumor necrosis factor alpha (TNF‐α) inhibitors and anti‐CD20 agents, are often used for autoimmune, inflammatory, and neoplastic disorders. While infection risk is well recognized, their association with rhinosinusitis remains poorly characterized. Goal To map the existing literature on TNF‐α and anti‐CD20 agents and rhinosinusitis and to identify emerging clinical patterns. Methods A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines. A systematic search of PubMed, Scopus, Web of Science, and Cochrane databases was performed. Studies that reported sinonasal outcomes in patients receiving TNF‐α inhibitors or anti‐CD20 agents were included. Results A total of 33 studies were included. The literature was limited and predominantly comprised of case reports and retrospective cohorts. Distinct patterns emerged between drug classes. TNF‐α inhibitors were primarily associated with new‐onset or severe rhinosinusitis, including opportunistic and invasive fungal infections, often without documented hypogammaglobulinemia. In contrast, anti‐CD20 therapy was consistently linked to recurrent bacterial rhinosinusitis within a broader sinopulmonary infection phenotype, frequently accompanied by secondary hypogammaglobulinemia. Several studies reported improvement in infection burden following immunoglobulin replacement therapy. Definitions of rhinosinusitis and outcome reporting were highly heterogeneous across studies. Conclusion Immunomodulator‐associated rhinosinusitis appears to manifest as two distinct phenotypes: a TNF‐α inhibitor related opportunistic infection pattern and an anti‐CD20 associated antibody‐deficiency phenotype. Prospective studies are needed to define incidence, risk stratification, and optimal screening and management strategies for sinonasal disease in this patient population.
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Authors: Obadah Tolaymat, John Dewey, Kushal Modi, Omar G. Ahmed, Antoine Azar, Fuad M. Baroody, Regan W. Bergmark, Peter Filip, Kent Lam, Jivianne T. Lee, Sandra Y. Lin, Amber Luong, Daniel C. O’Brien, Hassan H. Ramadan, Lindsey Ryan, Elina Toskala, Chadi A. Makary
Institutions: University of California, Los Angeles, Johns Hopkins University, University of South Florida, Johns Hopkins Medicine, Old Dominion University, Eastern Virginia Medical School, University of Wisconsin–Madison, University of Wisconsin Health, Methodist Hospital, University of Manitoba, The University of Winnipeg, West Virginia University, Massachusetts General Hospital, The University of Texas Health Science Center, Marshall University, Thomas Jefferson University, Wisconsin Division of Public Health, Rush University, Comer Children's Hospital