Sinonasal outcomes in patients with chronic rhinosinusitis with nasal polyps and severe asthma treated with mepolizumab: A real-life study

Mepolizumab is a monoclonal antibody targeting interleukin-5 that has been approved for the treatment of severe eosinophilic asthma (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to evaluate the sinonasal outcomes and safety of mepolizumab in patients with CRSwNP and SEA. This retrospective, real-life study included 19 patients aged 18 years and older who received 100 mg of subcutaneous mepolizumab every 4 weeks for at least 12 months. Sinonasal symptom severity, rhinorrhea, nasal congestion/obstruction, postnasal drip, and loss of smell were assessed using the visual analog scale (VAS). Disease-specific quality of life was assessed using the sino-nasal outcome test-22 (SNOT-22). The history of endoscopic sinus surgery (ESS) was evaluated for each patient. Asthma-related outcomes included the asthma control test (ACT), number of exacerbations, and daily systemic corticosteroid dose. Evaluations were conducted at baseline, 6 months (t6), and 12 months (t12). Adverse events were also recorded. The median age was 49 years (min-max: 29-63), and 57.9% of patients were female. Compared with baseline, significant improvements were observed in all VAS parameters and total/subdomain SNOT-22 scores at both t6 and t12. The number of asthma exacerbations and systemic corticosteroid doses decreased significantly. No patient required ESS during the follow-up period. Only two patients experienced mild injection-related side effects. Mepolizumab treatment has resulted in significant improvement in sinonasal symptoms and quality of life. These findings support the use of mepolizumab as a safe and effective option in selected patients with CRSwNP and concomitant SEA.