Purpose: To evaluate the real-life effectiveness of mepolizumab in patients with severe uncontrolled type-2 chronic rhinosinusitis with nasal polyps (CRSwNP), focusing on clinical, functional, and inflammatory outcomes. Methods: This retrospective study included 74 patients with uncontrolled type-2 CRSwNP treated with subcutaneous mepolizumab (100 mg every 4 weeks) for at least 12 months. Primary endpoints were changes in Sino-Nasal Outcome Test-22 (SNOT-22), Nasal Polyp Score (NPS). Secondary endpoints included Sniffin’ Sticks Identification Test-12 (SSIT-12), Lund-Mackay CT score (LMK-CT), blood eosinophils, total IgE, and Asthma Control Test (ACT). Outcomes were assessed at baseline and at 1, 3, 6, and 12 months. Results: Significant improvements were observed over 12 months. Mean SNOT-22 decreased from 76.2 ± 17.8 to 27.7 ± 15.6, and NPS from 6.3 ± 0.9 to 2.1 ± 0.7. LMK-CT scores improved from 17.2 ± 3.6 to 10.5 ± 4.2. Olfactory function improved, with normosmia increasing from 2.8% to 10.8%. Blood eosinophils decreased significantly (from 564 ± 62.9 to 82 ± 10.0 cells/μL), while total IgE remained stable. Asthma control improved rapidly, with all patients achieving ACT ≥20 within four weeks. Multivariate logistic regression identified higher baseline blood eosinophil counts (OR 1.42 per 100 cells/μL increase, 95% CI 1.08–1.87, p = 0.012) and lower baseline SSIT-12 scores (OR 0.78 per point increase, 95% CI 0.63–0.96, p = 0.021) as independent predictors of favorable response at 12 months. Conclusion: Mepolizumab provides sustained clinical and radiologic improvement in severe type-2 CRSwNP. Baseline eosinophilia and olfactory dysfunction may help identify patients more likely to benefit from anti-IL-5 therapy, supporting a personalized treatment approach.
Santis et al. (Mon,) studied this question.