Background-Though patients with chronic rhinosinusitis without nasal polyps (CRSsNP) represent a majority of the CRS population, they have not been completely characterized phenotypically. Objective-To perform a comprehensive phenotypic characterization of subjects with CRSsNP, using CRS with nasal polyps (CRSwNP) as a comparator. Methods-Patients with a history of CRS with positive sinus CT (>18 y.o.) evaluated in the Allergy/Immunology or Otolaryngology clinics of an academic center between 2002-2012 were identified via ICD-9 codes. Retrospective chart review was performed on a subset of 507 patients with CRSsNP and 874 with CRSwNP. Characteristics analyzed included demographics, comorbid conditions, and radiologic sinus severity.

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RATIONALE: Mepolizumab has been approved for treatment in severe eosinophilic asthma. However, there are no post-approval practice-based data on its effectiveness and safety. METHODS: We performed a retrospective chart review of patients who received mepolizumab for asthma and compared characteristics from 6 months prior to starting mepolizumab to 6 months after starting. Characteristics analyzed included demographics, history, asthma severity and eosinophil counts. RESULTS: We recruited twenty-four patients who received at least 6 months of continuous mepolizumab. Mean age was 51.0610.4 years and 17/24 (71%) were female. 19/24 (79%) had history of chronic rhinosinusitis (CRS), 14 of whom had nasal polyps. Immediately prior to starting mepolizumab, patients required a mean of 2.360.9 controller medications. 7/24 (29%) previously received omalizumab. After starting mepolizumab, eosinophil counts decreased by >90% (1.261.1 vs 0.1160.10/mm 3 , p50.0001). Total asthma exacerbations in 6 months decreased by >55% (2.261.8 vs 0.961.4, p50.0006) and number of steroid courses in 6 months decreased by >60% (2.361.8 vs 0.961.2, p50.0003). There was a small improvement in FEV1 (1.861.0 vs 1.961.0 liters, p50.025). The 10 patients who began mepolizumab while on chronic daily prednisone significantly reduced their daily prednisone dosage (9.463.6 mg vs 4.064.0 mg, p50.024). Based on overall global physician assessment, 22/24 (92%) had improvement in asthma control and 7/16 (44%) had improvement in CRS. A 36-year-old patient developed shingles, and 5 complained of new-onset fatigue. CONCLUSIONS: Real-world treatment of eosinophilic asthma with mepolizumab was associated with reduced oral steroid use and improvement in lung function, disease control, and fewer asthma exacerbations with minimal adverse effects.

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