Am J Allergy Asthma Immunol Res | Volume 1, Issue 1 | Research Article | Open Access
Mohammad Nabavi1, Afshin Rezaeifar1*, Saba Arshi1, Morteza Fallahpour1, Mohammad Hassan Bemanian1, Sima Shokri1, Parisa Rezaeifar2, Morteza Ghojazadeh3, Sima Bahrami1 and Omid Motamedi4
1Department of Allergy and Clinical Immunology, Iran University of Medical Sciences, Iran 2TB and Lung Disease Research Center, Tabriz University of Medical Sciences, Iran 3Research Center of Evidence-Based Medicine, Tabriz University of Medical Sciences, Iran 4Department of Radiology, Iran University of Medical Sciences, Iran
*Correspondance to: Afshin RezaeifarFulltext PDF
Background: P-glycoprotein 1 (permeability glycoprotein, abbreviated as P-gp or Pgp also known as Multi Drug Resistance protein 1 (MDR1) or ATP-Binding Cassette sub-family B member 1 (ABCB1) or Cluster of Differentiation 243 (CD243) is a new non-invasive diagnostic biomarker for therapeutic purposes in determining chronic rhinosinusitis endo types. Inhibition of this membrane transporter by verapamil has been recently used as a therapeutic target. Methods: We enrolled 36 patients between 18 to 55 years old with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) in a double-blind, placebo-controlled, randomized clinical trial. Patients in both group received similar treatment with intranasal mometasone and irrigation. In addition, the intervention group received 80 mg verapamil tablets three times daily for three months and the control group received placebo. Primary and secondary outcome measures such as Sino- Nasal Outcome Test (SNOT-22) and Lund-Mackay Score (LMS) assessed at the onset and the end of the intervention. The differences of quantitative variables between groups were evaluated by independent samples t-test and Mann-Whitney test. Paired-samples T test was performed to test the difference between two measurement times in each group. Chi-square and Fisher’s exact test were used for qualitative variables. Analysis of Covariance (ANCOVA) was performed to evaluate the differences between the intervention and control groups before and after the intervention. Results: The mean of SNOT22 after intervention (SNOT2: N Second measurement of SNOT22) for intervention group was 29.88 ± 18.80 and for control group was 52.27 ± 19.10 and the mean of LMS after intervention (LMS 2: Second measurement of LMS) for intervention group was 16.11 ± 6.99 and for control group was 16.77 ± 5.69. ANCOVA showed a significant change for SNOT22 between two groups (P=0.001), and β= -20.580 given the placebo group as the reference category, so the mean values of SNOT22 significantly decreased in intervention group compared to placebo group but no significant change occurred in LMS between two groups (P=0.784). Conclusion: In this study, we determined that p-gp inhibitors such as verapamil improve subjective symptoms like SNOT22 score, but we did not achieve any significant impact on objective measures.
Keywords: Chronic Rhinosinusitis (CRS); Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP); Verapamil; Lund-Mackay Score (LMS); Sino-Nasal Outcome Test (SNOT22); Endotype; Permeability-glycoprotein (p-gp)
Nabavi M, Rezaeifar A, Arshi S, Fallahpour M, Bemanian MH, Shokri S, et al. Efficacy of Verapamil in Chronic Rhinosinusitis with Nasal Polyposis: A Double-Blind and Placebo-Controlled Randomized Clinical Trial. Am J Allergy Asthma Immunol Res. 2022; 1(1): 1005..