Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic
ﬁbrosis: a systematic review
Gopi B. Shah, MD, MPH
, Linde De Keyzer, MD
, Joy A. Russell, PhD, MLS
and Ashleigh Halderman, MD
Background: A major component of sputum in cystic ﬁ-
brosis (CF) patients is polymerized DNA, a byproduct of
degraded neutrophils. Dornase alfa (dornase) selectively
cleaves extracellular DNA and reduces the viscosity of spu-
tum. It improves mucociliary clearance and pulmonary func-
tion. The beneﬁt of dornase on CF-associated sinusitis is
less clear. Therefore, the objective of this study was to sys-
tematically review the use of dornase on chronic rhinosi-
nusitis (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 be-
tween 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 dor-
nase signiﬁcantly improved sinonasal symptoms more than
saline alone. The impact on pulmonary function and radio-
graphic 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 eﬃ-
cacy of dornase alfa in the treatment of CRS in CF patients.
2018 ARS-AAOA, LLC.
CFTR; deoxyribonuclease; drug delivery; genetics;
How to Cite this Article:
Shah GP, De Keyzer L, Russell JA, Halderman A. Treat-
ment of chronic rhinosinusitis with dornase alfa in patients
with cystic ﬁbrosis: a systematic review. Int Forum Allergy
ystic ﬁbrosis (CF) is the most common genetic disor-
der in the Caucasian population. It is an autosomal
recessive disease caused by mutations of the cystic ﬁbro-
sis transmembrane conductance regulator gene (CFTR) on
chromosome 7. This leads to defects in the CFTR protein,
causing defective chloride transport on the apical surfaces
Department of Otolaryngology–Head and Neck Surgery, University of
Texas-Southwestern Medical Center and Children’s Health Dallas,
Department of Pulmonology, University of
Texas-Southwestern Medical Center and Children’s Health, Dallas, TX;
Health Sciences Digital Library and Learning Center, University of
Texas-Southwestern Medical Center, Dallas, TX
Correspondence to: Gopi Shah, MD, MPH, Department of Otolaryngology,
Division of Pediatric Otolaryngology, University of Texas-Southwestern
Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390; e-mail:
Received: 21 October 2017; Revised: 1 December 2017; Accepted:
7 December 2017
View this article online at wileyonlinelibrary.com.
of epithelial cells. With this defective chloride transport,
there is reduced water content, resulting in thick and vis-
cous secretions, affecting the upper and lower airways and
the gastrointestinal/digestive and reproductive systems. The
most common clinical manifestations are pulmonary exac-
erbations with bacterial colonization and inﬂammation.
The paranasal sinuses may be involved in 50–100%
of patients with CF based on clinical or radiologic ex-
amination showing nasal polyps, mucosal swelling, and
thick inspissated secretions. Sinonasal symptoms may be
underreported as only 10% of pediatric patients report
sinonasal complaints, predominately nasal obstruction or
The paranasal sinuses can also act as a
reservoir for bacterial pathogens (ie, Pseudomonas aerug-
inosa, Burkholderia cepacia, Achromobacter xyloxidans,
etc), leading to sinusitis and pulmonary infections.
ical management of sinus disease consists of sinus rinses,
antibiotic therapy, and topical steroids; however, no deﬁni-
tive “maximal medical therapy” or gold standard current
729 International Forum of Allergy & Rhinology, Vol. 8, No. 6, June 2018