Abstract Rationale Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent comorbidity in patients with severe asthma (SA) and type 2 (T2) inflammation, potentially influencing disease burden and treatment response. The presence of CRSwNP in SA patients indicates elevated T2 inflammation, which may enhance the response to mepolizumab, an anti-IL-5 monoclonal antibody. Methods TYREX is a multicenter, retrospective, observational study that recruited patients with severe asthma treated with mepolizumab for ≥12 months and up to 5 years (mean treatment duration: 4.09 years, SD: 2.07 years; median: 3.99 years, range min-max: 1.02-7.77). For this analysis, patients were stratified according to the presence or absence of baseline comorbid CRSwNP. Clinical outcomes assessed included exacerbation rates, oral corticosteroid (OCS) use, asthma control (ACT score), lung function (pre-BD FEV1%), and clinical remission, defined as the absence of exacerbation, no OCS use, ACT ≥20, and FEV1 ≥80%. Statistical comparisons were performed at 12 months and at the end of follow-up. Results A total of 446 patients were included in the TYREX study, of whom 208 patients had comorbid CRSwNP at baseline. At 12 months, patients with CRSwNP showed a trend toward a greater reduction in exacerbations than those without CRSwNP (-80.14% vs -75.64%), which persisted at the end of follow-up. Maintenance OCS use decreased by 81.9% in the CRSwNP group at 12 months and by 90.9% at the end of follow-up, compared with -66.4% and -83.6% in patients without CRSwNP. ACT scores improved in both groups, with numerically greater gains in the CRSwNP group, while FEV1% showed comparable improvements across cohorts and periods. Clinical remission was achieved by 34.21% of patients with CRSwNP at 12 months, compared with 24.74% in the CRSwNP-free group (p = 0.0538). At the end of follow-up, remission rates were 35.26% and 29.73%, respectively, with no statistically significant difference between them. Full details are provided in Table 1. Conclusion The presence of CRSwNP is associated with numerically better outcomes and a higher percentage of clinical remission at 12 months and in the long term in patients with severe asthma treated for 5 years with mepolizumab, a biologic with an indication for both severe asthma and CRSwNP. This abstract is funded by: GSK Spain S.A.
Perez-De-Llano et al. (Fri,) studied this question.
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