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Monitoring mepolizumab treatment in chronic rhinosinusitis with nasal polyps (CRSwNP): Discontinue, change, continue
Ludger Klimek1, Ulrike Förster-Ruhrmann2, Heidi Olze2
1Center for Rhinology and Allergology, Wiesbaden.
Background:
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL-5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy should be monitored, what follow-up documentation is necessary, and when it should be discontinued if necessary.
Materials And Methods:
A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries, and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered.
Results:
Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals, and possible therapy breaks as well as discontinuation of therapy when using mepolizumab for the indication CRSwNP in the German healthcare system are given on the basis of a documentation sheet.
Conclusion:
Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.
Insights
Mepolizumab is an anti-IL-5 antibody for severe chronic rhinosinusitis with nasal polyps (CRSwNP). This study provides recommendations for monitoring, follow-up, and discontinuation of mepolizumab therapy in CRSwNP patients.
Area of Science:
- Immunology
- Otolaryngology
- Pharmacology
Background:
- Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory condition often characterized by eosinophilic inflammation.
- Mepolizumab, an anti-IL-5 antibody, is approved for severe CRSwNP cases unresponsive to conventional treatments like systemic glucocorticosteroids or surgery.
- Current guidelines lack specific details on monitoring and managing mepolizumab therapy in CRSwNP.
Purpose of the Study:
- To establish clear recommendations for the monitoring, follow-up, and discontinuation of mepolizumab therapy in adults with severe CRSwNP.
- To provide guidance for healthcare professionals within the German healthcare system regarding mepolizumab treatment for CRSwNP.
- To address the need for standardized protocols in managing biologic therapy for CRSwNP.
Main Methods:
- A comprehensive literature search was conducted using Medline, Pubmed, trial registries, and the Cochrane Library.
- Analysis included human studies published up to October 2022 focusing on mepolizumab treatment for CRSwNP.
- Expert panel consensus and international literature informed the development of the recommendations.
Main Results:
- Recommendations were developed for follow-up schedules and adherence to therapy intervals for mepolizumab in CRSwNP.
- Guidelines address potential therapy breaks and criteria for discontinuing mepolizumab treatment.
- A documentation sheet was created to support the implementation of these recommendations.
Conclusions:
- Biologic therapies like mepolizumab offer new non-surgical options for severe, refractory CRSwNP based on its immunological underpinnings.
- The provided recommendations aim to optimize mepolizumab use as an add-on therapy for severe CRSwNP.
- Standardized monitoring and management are crucial for effective and safe use of mepolizumab in CRSwNP treatment.
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