A comparison of doxycycline and conventional treatments of refractory chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis

Purpose: To compare the effects of doxycycline (DOX) and conventional management in patients with refractory chronic rhinosinusitis and nasal polyps (CRSwNP). Methods: Six databases were searched to September 2023. We retrieved studies that compared improvements in refractory chronic sinusitis-related symptoms between DOX-treated and control groups. Results: DOX significantly reduced the Lund-Kennedy (LK) score [− 0.3670 (range − 0.6173; − 0.1166); I² = 92.8%], the nasal polyposis score [− 0.9484 (− 1.2287; − 0.6680); I² = 92.5%], the patient-reported Sinonasal Outcome Test (SNOT) score [− 0.3141 (− 0.4622; − 0.1660); I² = 91.2%], and the nasal obstruction score [− 0.1813 (− 0.3382; − 0.0243); I² = 86.2%]. On subgroup analyses by the measurement timepoints, the extent of nasal polyposis was significantly lower in the DOX group during treatment, at the end of treatment, and 4 and 8 weeks later. The LK scores also indicated improvements during treatment and at the end of treatment. The SNOT score tended to decrease with time in the treatment group. Nasal obstruction symptoms improved during treatment and 4 weeks later. Conclusion: DOX enhances the postoperative endoscopic outcomes of refractory CRSwNP patients by reducing recurrent polyposis and inflammation.