Mepolizumab Reduces Systemic Corticosteroid Use in Chronic Rhinosinusitis With Nasal Polyps

Area of Science:

• Pulmonology and Allergy
• Otolaryngology

Background:

• Systemic corticosteroids (SCSs) are commonly used for severe chronic rhinosinusitis with nasal polyps (CRSwNP).
• SCSs are associated with significant short- and long-term adverse effects, necessitating alternative treatment strategies.

Purpose of the Study:

• To evaluate the efficacy of mepolizumab in patients with severe CRSwNP based on prior SCS use.
• To characterize the SCS-sparing potential of mepolizumab in this patient population.

Main Methods:

• The randomized, double-blind, phase III SYNAPSE trial included adults with severe CRSwNP eligible for surgery despite standard care.
• Participants received mepolizumab (100 mg) or placebo subcutaneously every 4 weeks for 52 weeks.
• Post hoc analyses assessed treatment responses based on prior SCS courses and evaluated mepolizumab's SCS-sparing effect by analyzing time to first SCS course and total corticosteroid dose.

Main Results:

• Mepolizumab demonstrated improved treatment responses compared to placebo, irrespective of prior SCS use.
• The probability of requiring SCSs by week 52 was lower with mepolizumab (25.4%) versus placebo (37.5%).
• In patients requiring SCSs, mepolizumab was associated with a lower mean annual prednisolone-equivalent dose compared to placebo.

Conclusions:

• Mepolizumab provides clinical benefits for severe CRSwNP patients, independent of their history of SCS use.
• Mepolizumab exhibits a notable SCS-sparing effect, potentially reducing the long-term risks associated with corticosteroid therapy.