One year mepolizumab outcomes in severe, uncontrolled CRSwNP: a real-life study

This study aimed to evaluate the effectiveness of mepolizumab in the treatment of severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) as add-on therapy to intranasal corticosteroids (INCS) in a real-life setting over the first year of treatment.

We included 50 patients (28 males; mean age: 56.4 years, range 35-77) who received mepolizumab 100 mg every 4 weeks. The primary objective of this study was to evaluate the reduction in nasal polyp size and improvement in patients' quality of life, measured through symptom-based questionnaires. The secondary objective was to evaluate improvements in smell dysfunction, severity of comorbidities, blood eosinophilia, and the need for surgery or systemic steroids.

After 12 months of treatment, the median nasal polyp score (NPS) decreased from 5 to 2 and the mean sino-nasal outcome test-22 (SNOT-22) score decreased from 58.4±21 to 26.1±17.5. Olfaction only slightly improved with a median VAS score decreasing from 10 at baseline to 6 at 12 months. Seven patients remained uncontrolled and required systemic steroids and in 5 cases also endoscopic sinus surgery.

The results support the use of mepolizumab as an effective option in the current standard of care for patients affected by severe, uncontrolled CRSwNP especially in decreasing nasal polyps’ size and improving quality of life, although a minor impact was observed on recovery of smell.