A Multidimensional Approach to 12-Month Response to Mepolizumab in Severe Chronic Rhinosinusitis with Nasal Polyps: A...

Although randomised clinical trials have demonstrated the efficacy of mepolizumab in severe chronic rhinosinusitis with nasal polyps (CRSwNP), treatment response in routine clinical practice extends beyond sinonasal outcomes alone and often requires simultaneous assessment of symptom burden, asthma control, and eosinophilic inflammation. Real-world multidimensional evaluations remain limited. This study aimed to evaluate the 12-month clinical response to mepolizumab in patients with severe, uncontrolled CRSwNP using a structured multidimensional assessment framework.

This retrospective single-centre real-world study included adult patients with severe, uncontrolled CRSwNP treated with mepolizumab. All patients had undergone at least two prior endoscopic sinus surgeries and had evidence of type 2 inflammation. Response at 12 months was evaluated across five domains: endoscopic findings, quality of life, nasal symptoms, olfactory symptoms, and asthma control and absence of systemic corticosteroid rescue treatment. Overall response was classified as excellent, partial, or no response. Changes in Nasal Polyp Score (NPS), Sinonasal Outcome Test-22 (SNOT-22), visual analogue scale (VAS) scores, Asthma Control Test (ACT), and blood eosinophil counts were analysed.

Ten patients were included. Improvements were observed in NPS (5.3-2.7; p = 0.008), SNOT-22 (63.9-34.6; p = 0.004), nasal VAS (7.0-4.3; p = 0.047), olfactory VAS (9.0-5.9; p = 0.008), ACT (16.2-21.2; p = 0.047), and blood eosinophils (502.2-77.0 cells/µL; p = 0.004). According to the revised multidimensional assessment framework, 5 patients (50%) achieved an excellent response and 5 patients (50%) achieved a partial response. One patient required rescue systemic corticosteroids during follow-up. No patient fulfilled the predefined criteria for non-response.

In this small real-world cohort, mepolizumab was associated with improvement across multiple clinically relevant domains in patients with severe CRSwNP. These findings should be considered exploratory and require confirmation in larger prospective studies.