Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review

Background: A major component of sputum in cystic fibrosis (CF) patients is polymerized DNA, a byproduct of degraded neutrophils. Dornase alfa (dornase) selectively cleaves extracellular DNA and reduces the viscosity of sputum. It improves mucociliary clearance and pulmonary function. The benefit of dornase on CF-associated sinusitis is less clear. Therefore, the objective of this study was to systematically review the use of dornase on chronic rhinosinusitis (CRS) in CF patients. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed for this systematic review. Ovid Medline, EMBASE, PubMed, and the Cochrane Library were searched. The search terms “dornase alfa,” “deoxyribonucleases,” “rhinosinusitis,” and “cystic fibrosis” were used to find articles published between 1990 and 2016. The articles were reviewed for study design, level of evidence, and clinical outcomes. Results: Sixty-two articles were identified; 6 met the inclusion criteria (104 patients). Improvement measured by sinonasal symptoms, endoscopic and radiographic findings, and pulmonary function was variably reported between the studies. Sinonasal symptoms were shown to improve in all studies with use of intranasal topical dornase. Three placebo-controlled studies showed that topical dornase significantly improved sinonasal symptoms more than saline alone. The impact on pulmonary function and radiographic and endoscopy findings was variable. Conclusion: Topical intranasal dornase appears to improve sinonasal symptoms in CF patients to a greater degree than saline alone. The impact on other outcomes is less clear. Larger studies are needed to fully elucidate the true efficacy of dornase alfa in the treatment of CRS in CF patients.