Defining the Role and Clinical Relevance of Periostin in Chronic Rhinosinusitis with or without Nasal Polyps: a Systematic Review and Meta-analysis

To determine the clinical relevance of periostin as a biomarker in chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), with a focus on its utility in disease classification, evaluating disease burden, and monitoring therapeutic outcomes. A meta-analysis of 20 studies involving 2,869 patients demonstrated significantly elevated periostin levels in CRSwNP, particularly in patients with comorbid asthma. Serum periostin measurements were more consistent than tissue-based assays. Elevated periostin correlated with eosinophilic inflammation, higher sinus computed tomography opacity score, and overall disease burden. While it may play a role in assessing the effectiveness of treatment, its significance in biological therapy is not reliably shown. Periostin could serve as a useful addition to eosinophil counts when assessing type 2 inflammation in CRSwNP. It has the potential to aid in identifying patients with a substantial disease burden. However, its role in monitoring treatment response remains uncertain and needs more study. Future investigations should focus on its combined use with other biomarkers, relevance to treatment effectiveness, and establishing clinical cut-off points.