Favorable clinical efficacy of mepolizumab on the upper and lower airways in severe eosinophilic asthma: a 48-week pilot study

Objective.Assessing efficacy of mepolizumab on the upper and lower airways in severe eosinophilic asthma patients.Patients and methods.This study was a 48-week prospective open-label analysis of mepolizumab in 11 asthmatics with chronic rhinosinusitis (CRS).It was administered every 4 weeks.Six patients were aspirin-exacerbated respiratory disease (AERD).Results.Blood eosinophil count was reduced after the first administration, and was continued until 48 weeks.The Sino-Nasal Outcome Test scores, the Lund-MacKay CT scoring, and forced expiratory volume in 1 second were improved.Symptom scores of anosmia and nasal congestion were not improved in the patients with AERD.All oral corticosteroid-dependent patients successfully withdrew from corticosteroids.Conclusions.This pilot study showed mepolizumab improved nasal symptoms and lung function in severe eosinophilic asthma patients with CRS, suggesting efficacy of mepolizumab on the upper and lower airway symptoms in eosinophilic asthma.ture, and cytokine profiles in the Japanese resembled those in Europe and the United States (9-11).Because IL-5 plays a key role on chemotaxis, differentiation, activation, and survival of eosinophils (12), and because those cells represent such prominent characteristics in the polyps, antagonism of IL-5 has been considered a therapeutic target.The first pilot study with reslizumab, a humanized IL-5 antibody, showed a significant reduction of the size of nasal polyps after a single intravenous injection (13).Hence, the principle of IL-5 antagonism was established in eosinophilic nasal polyps.Mepolizumab, a humanized IgG 1 monoclonal antibody that blocks human IL-5 from binding to the IL-5 receptor, has been shown to be a potential novel therapeutic approach in patients with severe eosinophilic nasal polyposis ( 14).An international randomized, double-blinded, placebo-controlled, multicenter study including 105 patients treated with mepolizumab or placebo showed that in patients with recurrent nasal polyposis re-