Subcutaneous Mepolizumab treatment for chronic rhinosinusitis decreases nasal polyps and obstruction

A group of researchers led by Claus Bachert conducted a study which showed that regardless of the existence of asthma or aspirin-exacerbated respiratory illness (AERD), mepolizumab decreased polyp size and nasal obstruction in Chronic Rhinosinusitis with Nasal Polyp (CRSwNP).

The findings of this study were published in the Journal of Allergy and Clinical Immunology.

Mepolizumab decreased nasal polyp (NP) size and nasal obstruction in CRSwNP in the Phase III SYNAPSE research. As a result, the goal of this study was to evaluate the effectiveness of mepolizumab in SYNAPSE patients classified by concomitant asthma, AERD, and baseline blood eosinophil count (BEC).

SYNAPSE, a 52-week randomized, double-blind trial (NCT03085797), comprised individuals with severe bilateral CRSwNP who were surgical candidates despite intranasal corticosteroid therapy. For 52 weeks, patients were given subcutaneous mepolizumab 100 mg four times a week or placebo, in addition to usual therapy. Changes in total endoscopic NP score (Week 52) and nasal obstruction visual analogue scale (VAS) score (Week 49–52) were co-primary objectives. The subgroup analyses by concomitant asthma and AERD status, as well as the post-hoc analysis by BEC, were exploratory.

The key findings of this study were as follow:

1. The study comprised 407 people (289 with asthma, 108 with AERD, and 371 and 278 with BEC counts of 150 or 300 cells/L, respectively).

2. The proportion of patients with a 1-point improvement from baseline in NP score was higher with mepolizumab versus placebo across comorbid diseases (asthma: 52.9% vs 29.5 % ; AERD: 51.1% vs 20.6%) and baseline BEC subgroups (150 cells/L: 55.0 percent vs 31.3 % ; 150 cells/L: 49.5% vs 28.1 % ; 300 cells/L: 50.7 %.

3. A similar pattern was found in patients who did not have concomitant asthma or AERD.

4. Across all comorbid categories, mepolizumab resulted in a more than 3-point improvement in nasal obstruction VAS score compared to placebo.

In conclusion, 100 mg subcutaneous mepolizumab administration every 4 weeks decreased NP size, nasal obstruction, surgical risk, and systemic corticosteroid usage, with a trend for larger improvement in individuals with higher baseline blood eosinophil levels. The medication also alleviated nasal symptoms in individuals with severe, bilateral CRSwNP, whether they had asthma, AERD, or both. Mepolizumab should be investigated for the treatment of CRSwNP, especially in individuals who also have asthma or AERD.

Reference:

 Bachert C, Sousa AR, Han JK, Schlosser RJ, Sowerby LJ, Hopkins C, Maspero JF, Smith SG, Kante O, Karidi-Andrioti DE, Mayer B, Chan RH, Yancey SW, Chaker AM, Mepolizumab for chronic rhinosinusitis with nasal polyps: treatment efficacy by comorbidity and blood eosinophil count, Journal of Allergy and Clinical Immunology (2022), doi:https://doi.org/10.1016/j.jaci.2021.10.040