Mepolizumab decreases tissue eosinophils while increasing type‐2 cytokines in eosinophilic chronic rhinosinusitis

Walter, Sophie; Ho, Jacqueline J; Alvarado, Raquel; Smith, Guillaume; Croucher, David R.; Liang, Sharron; Grayson, Jessica W.; Mangussi‐Gomes, João; Es, Simone L. Van; Earls, Peter; Rimmer, Janet; Campbell, Raewyn; Kalish, Larry; Sacks, Raymond; Harvey, Richard J.

doi:10.1111/cea.14152

Cited by 14 publications

(18 citation statements)

References 69 publications

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“…In two studies on patients with CRSwNP, mepolizumab added to daily INCS treatment led to a reduction in the need for ESS, improved sinonasal symptoms, endoscopic polyp size, and sinus opacification [ 136 , 137 , 138 ]. Mepolizumab reduces SM eosinophils, but concurrently can lead to a local type-2 inflammatory feedback loop [ 139 ]. Mepolizumab is characterized by a good safety profile.…”

Section: New Emerging Immunomodulating Therapeutic Options—biologicsmentioning

confidence: 99%

Perspectives in Therapy of Chronic Rhinosinusitis

et al. 2022

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The recent classification of chronic rhinosinusitis (CRS) focusses on investigating underlying immunopathophysiological mechanisms. Primary CRS is subdivided based on endotype dominance into type 2 (that relates mostly to the Th2 immune response with high levels of IL-5, IL-13, and IgE), or non-type 2 (that corresponds to the mix of type 1 and type 3). The treatment selection of CRS is dependent on endotype dominance. Currently, the majority of patients receive standardized care—traditional pharmacological methods including local or systemic corticosteroids, nasal irrigations or antibiotics (for a selected group of patients). If well-conducted drug therapy fails, endoscopic sinus surgery is conducted. Aspirin treatment after aspirin desensitization (ATAD) with oral aspirin is an option for the treatment in nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) patients. However, in this review the focus is on the role of biological treatment—monoclonal antibodies directed through the specific type 2 immune response targets. In addition, potential targets to immunotherapy in CRS are presented. Hopefully, effective diagnostic and therapeutic solutions, tailored to the individual patient, will be widely available very soon.

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Section: New Emerging Immunomodulating Therapeutic Options—biologicsmentioning

confidence: 99%

Perspectives in Therapy of Chronic Rhinosinusitis

et al. 2022

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“…The findings suggest that mepolizumab's effectiveness in eosinophilic chronic rhinosinusitis appears to reflect its ability to decrease tissue eosinophil numbers, while the increase in type 2 cytokines may explain incomplete drug response. Adapted from reference 1 …”

Section: Figurementioning

confidence: 99%

“…The first article describes how mepolizumab decreases tissue eosinophils while increasing type 2 cytokines in eosinophilic chronic rhinosinusitis. 1 Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease of the upper airways that often have a profound deleterious effect on the quality of life (QoL) of patients. 2 Moreover, it has a significant societal and economic burden.…”

Section: Mepolizumab For Eosinophilic Chronic Rhinosinusitis Loss Of ...mentioning

confidence: 99%

“…In this month's editorial, we discuss three very interesting studies selected by the Editors of the journal. The first article describes how mepolizumab decreases tissue eosinophils while increasing type 2 cytokines in eosinophilic chronic rhinosinusitis 1 …”

Section: Figurementioning

confidence: 99%

“…Mohamed H. Shamji 1,2 Robert J. Boyle Email: m.shamji@imperial.ac.uk F I G U R E 1 Eosinophilic chronic rhinosinusitis represents a type 2 inflammatory condition, which is often treatment resistant. Following treatment with mepolizumab in patients with eosinophilic chronic rhinosinusitis, sinonasal eosinophil counts decreased.…”

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confidence: 99%

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Mepolizumab for eosinophilic chronic rhinosinusitis, loss of smell and challenges with accessibility to allergen immunotherapy

Shamji

Boyle

2022

Clin Experimental Allergy

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Clinical feature‐based diagnosis criteria of eosinophil and non‐eosinophil chronic rhinosinusitis in Taiwan

Ma,

Hsieh,

Huang

et al. 2023

Laryngoscope Investig Oto

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BackgroundThe prevalence of eosinophilic chronic rhinosinusitis (ECRS) has increased in Taiwan with a higher recurrence rate of nasal polyps after surgery. Therefore, we aimed to formulate the pre‐operative diagnostic criteria for patients with ECRS in Taiwan.MethodsThis case–control study included patients diagnosed with CRS with nasal polyps (CRSwNP) who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into ECRS and non‐eosinophilic CRS (NECRS) groups based on their histopathology. Demographic data, symptom severity scores, and computed tomography findings of the two groups were analyzed. We utilized receiver operating characteristic curve (ROC) analysis to evaluate parameters that could predict the diagnosis of ECRS.ResultsTotal 408 CRSwNP patients were enrolled (ECRS group: 163; NECRS group: 245). ECRS group was strongly associated with asthma (6.1% vs. 2.0%, p = .03), higher blood eosinophil counts (4.3% vs. 2.7%, p < .01), higher serum IgE (285.3 vs. 50.2 IU/mL, p = .02), and higher 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score (40.5 vs. 36.7, p = .03). The ECRS criteria based on ROC curve included the SNOT‐22 (>45, 2 points), serum eosinophil count percentage (>4%, 4 points), asthma (4 points), total serum IgE (>140 IU/mL, 4 points), Lund–Mackay score (>9.5, 4 points), and ethmoid‐to‐maxillary opacification ratio on CT (>1.5, 5 points). The cutoff score was 14 points (sensitivity, 70.2%; specificity, 93.3%).ConclusionsClinical‐feature‐based criteria may predict the diagnosis of ECRS before FESS in Taiwan.Level of EvidenceLevel 3.

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Mepolizumab decreases tissue eosinophils while increasing type‐2 cytokines in eosinophilic chronic rhinosinusitis

Cited by 14 publications

References 69 publications

Perspectives in Therapy of Chronic Rhinosinusitis

Perspectives in Therapy of Chronic Rhinosinusitis

Mepolizumab for eosinophilic chronic rhinosinusitis, loss of smell and challenges with accessibility to allergen immunotherapy

Clinical feature‐based diagnosis criteria of eosinophil and non‐eosinophil chronic rhinosinusitis in Taiwan

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