Eosinophil paradox with mepolizumab in chronic rhinosinusitis with nasal polyposis

Lipworth, Brian J.; Chan, Rory; Kuo, Chris RuiWen

doi:10.1016/j.jaci.2020.05.054

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…By contrast, some real-life studies have shown some disagreements on Mepolizumab’s ability to reduce the extent of nasal polyps [ 48 , 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Evidence of Mepolizumab Treatment in Chronic Rhinosinusitis with Nasal Polyps: A Multicentric Study

Cavaliere,

Loperfido,

Ciofalo

et al. 2024

JCM

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Background: The introduction of biological drugs in the management of chronic rhinosinusitis with nasal polyps (CRSwNP) is allowing new and increasingly promising therapeutic options. This manuscript aims to provide a multicenter trial in a real-life setting on Mepolizumab treatment for severe uncontrolled CRSwNP with or without comorbid asthma. Methods: A retrospective data analysis was jointly conducted at the Otolaryngology–Head and Neck Surgery departments of La Sapienza University and San Camillo Forlanini Hospital in Rome. Both institutions participated by sharing clinical information on patients with CRSwNP treated with Mepolizumab. Patients were evaluated before starting Mepolizumab, at six months and at twelve months from the first drug administration. During follow–up visits, patients underwent endoscopic evaluation, quality of life assessment, nasal symptoms assessment, and blood tests to monitor mainly neutrophils, basophils, eosinophils, and IgG, IgA, and IgE assay. Results: Twenty patients affected by CRSwNP and treated with Mepolizumab were enrolled (12 females and 8 males with a mean age of 63.7 years). Sixteen patients (80%) had concomitant asthma. During follow-up, a gradual improvement in nasal polyp score, quality of life and nasal symptoms, assessed by SNOT-22 and VAS and loss of smell measured by olfactory VAS, was found. Regarding blood tests, eosinophils decreased gradually, while other blood parameters showed no statistically significant changes. Conclusions: Mepolizumab has been shown to be effective in the therapeutic management of patients with CRSwNP. Further studies are needed to support our findings and better understand the underlying immune pathways to predict patients’ response to biological treatment in CRSwNP.

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“…By contrast, some real-life studies have shown some disagreements on Mepolizumab’s ability to reduce the extent of nasal polyps [ 48 , 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Evidence of Mepolizumab Treatment in Chronic Rhinosinusitis with Nasal Polyps: A Multicentric Study

Cavaliere,

Loperfido,

Ciofalo

et al. 2024

JCM

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“…The paradox that the depletion of blood eosinophils may not proceed in parallel with the reduction in clinical and endoscopic impact of sinonasal disease has long been a subject of debate [ 4 , 10 , 34 ]. However, most of published RLSs, assessing the effect of mepolizumab treatment in SEA patients with comorbid CRSwNP, are in line with the results achieved in RCTs in terms of CRS clinical control [ 5 , 9 , 11 , 29 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, analyses often rely only on patient-reported outcomes (sometimes not even standardized with validated scoring systems) [ 9 ]. Moreover, some discrepancies on the ability of mepolizumab to reduce NP volume emerged from isolated real-life studies [ 4 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Mepolizumab Improves Outcomes of Chronic Rhinosinusitis with Nasal Polyps in Severe Asthmatic Patients: A Multicentric Real-Life Study

Gallo

Castelnuovo

Spirito

et al. 2022

JPM

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Objective: The upcoming introduction of mepolizumab represents a promising treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). The present study aimed to evaluate the effectiveness of mepolizumab on sinonasal outcomes of comorbid CRSwNP and severe asthma in a real-life setting. The primary endpoint was to evaluate changes in the SinoNasal Outcome Test (SNOT)-22 score, Nasal Polyp (NP) score, and blood eosinophil count during a 12-month treatment with mepolizumab. Secondary endpoints were to quantify mepolizumab’s effects on the mentioned parameters, identify clinical variables influencing the degree of response to treatment, and portray responder and nonresponder patients. Methods: A multicentric retrospective no-profit observational study on severe asthmatic patients, treated with mepolizumab, and comorbid CRSwNP was conducted. All patients were followed for at least 12 months. SNOT-22 score, NP score, and blood eosinophil count (and other CRS-specific variables) were collected at baseline and after 12 months. Results: Forty-three patients were included. A statistically significant reduction was observed for SNOT-22 score (mean t0 SNOT-22 54.8 ± 25.9; mean t12 SNOT-22 31.5 ± 21.3, p < 0.0001), NP score (median t0 NPS 3 (IQR 3); median t12 NPS 2 (IQR 4), p < 0.0001), and blood eosinophil count (mean t0 blood eosinophils 804.7 ± 461.5 cell/µL; mean t12 blood eosinophils 107.5 ± 104.6 cell/µL, p < 0.0001) after 12 months of treatment. Twenty patients (47%) gained improvement both in clinical and endoscopic outcome. Mepolizumab responder patients presented a t0 SNOT-22 significantly higher than nonresponders (p = 0.0011). Conclusions: Mepolizumab improved CRSwNP outcomes in a population of severe asthmatic patients. No clinical feature emerged to outline the profile of a “typical” responder patient, except for baseline SNOT-22 score, which seemed to affect the response to treatment. Further studies would be necessary to supplement these preliminary evaluations.

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Howarth¹,

Bachert

Chan

2020

Journal of Allergy and Clinical Immunology

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Eosinophil paradox with mepolizumab in chronic rhinosinusitis with nasal polyposis

Cited by 5 publications

References 4 publications

Real-Life Evidence of Mepolizumab Treatment in Chronic Rhinosinusitis with Nasal Polyps: A Multicentric Study

Real-Life Evidence of Mepolizumab Treatment in Chronic Rhinosinusitis with Nasal Polyps: A Multicentric Study

Mepolizumab Improves Outcomes of Chronic Rhinosinusitis with Nasal Polyps in Severe Asthmatic Patients: A Multicentric Real-Life Study

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