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Mepolizumab benefits patients with nasal polyps regardless of co-existing conditions

Published: January 6, 2022

Patients who have inflammation in the air-filled passages around the nose and eyes (sinuses) along with obstructed nasal passages over a long period of time are often diagnosed with chronic rhinosinusitis (CRS). If these patients also have growths in the lining of the nose (nasal polyps; NP), they have a subset of CRS, termed CRSwNP. The inflammation in CRSwNP is caused by immune cells and signaling molecules, called cytokines. One of these cytokines is interleukin (IL)-5 and this cytokine has a key role in controlling the function of eosinophils (a type of white blood cell). Patients with an increased number of eosinophils in their blood or co-existing conditions such as asthma or aspirin-exacerbated respiratory disease (AERD) usually have more severe symptoms of CRSwNP. Standard types of treatments for CRSwNP include corticosteroids (which are associated with side effects), or nasal surgery (which may need to be repeated).  

Mepolizumab is an antibody therapy which specifically targets the inflammation in CRSwNP by binding to and blocking IL-5. Mepolizumab was approved for the treatment of CRSwNP in 2021 based on the results from the randomized controlled SYNAPSE study. This study showed that mepolizumab treatment in patients with CRSwNP was well-tolerated, helped reduce the size of NP and the nasal obstruction they cause, delayed the need for surgery, and reduced symptoms.

In a recent research article in The Journal of Allergy and Clinical Immunology (JACI), Bachert and colleagues presented additional data from SYNAPSE. These data were split into three groups based on whether patients had an increased number of eosinophils in their blood or had co-existing conditions (asthma or AERD). Over 52 weeks of the study, patients received mepolizumab or placebo in addition to their standard type of treatment. At the start and the end of the study, NP size and the amount of nasal obstruction were assessed.

In the analysis reported by Bachert and colleagues, over half of the patients with CRSwNP also had an increased number of eosinophils in their blood at the start of the study or had asthma, while approximately one quarter had AERD. Across all patient groups, more patients had a reduction in their NP size and less obstruction of their nasal passages with mepolizumab treatment compared with placebo.

The findings of this study highlight that mepolizumab is of benefit and may be considered as a treatment option for patients with CRSwNP. These findings are also important for patients who have more severe disease, such as those with co-existing conditions such as asthma or AERD.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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Graphical Abstract