Effects of Reslizumab on Asthma Outcomes in a Subgroup of Eosinophilic Asthma Patients with Self-Reported Chronic Rhinosinusitis with Nasal Polyps

Background: Severe eosinophilic asthma is frequently associated to chronic rhinosinusitis and nasal polyposis (CRSwNP) that contribute to poor asthma control. Mepolizumab is an anti-IL-5 monoclonal antibody, approved for the treatment of severe eosinophilic asthma. A limited number of studies have assessed the efficacy of mepolizumab on CRSwNP in severe asthmatics. We aim to evaluate the efficacy of mepolizumab on sino-nasal symptoms, polyp growth and asthma control in severe eosinophilic asthma patients with CRSwNP in real life. Methods: In this study 44 severe eosinophilic asthma patients with CRSwNP were treated with mepolizumab (100 mg q4w) for 1 year. The following outcomes were assessed before (T0), after 6 (T6) and 12 months (T12) of treatment: sino/nasal outcome test (SNOT-22), Total Endoscopic Nasal Polyp Score (TENPS), %FEV1 (FEV1/FEV1 predicted) and Asthma control test (ACT). Blood eosinophil count, exhaled nitric oxide (FENO) and prednisone intake were measured. In a subgroup of patients, nasal cytology was performed before (T0), after 6 (T6) and after 12 months (T12) of treatment with mepolizumab. Results: We reported a significant reduction of SNOT-22 [from 51.5 ± 21.2 at baseline (T0) to 31.70 ± 17.36 at T6 and 29.7 ± 21.5 at T12 (T0–T12 p < 0.001)] and a decrease of TENPS (from 2.88 ± 3.07 to 1.70 ± 2.37 and 1.77 ± 2.56 at T0, T6 and T12, respectively, T0–T12 p = 0.99). A significant improvement of %FEV1, ACT and a decrease in blood eosinophils and mean prednisone intake were also reported. No statistically significant decreasing trend was measured for FENO. Nasal cytology findings suggest a significant reduction of eosinophil percentage following mepolizumab treatment (from 16.8 ± 7.2% to 3.6 ± 6.2% and 0.8 ± 2.4% at T0, T6 and T12 respectively, T0 to T12: p < 0.001). Conclusions: Mepolizumab improves sino-nasal and asthma symptoms and reduces polyp growth in patients with severe eosinophilic asthma and concomitant CRSwNP in real life. The reviews of this paper are available via the supplemental material section.

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Recovery of Sense of Smell by Mepolizumab in a Patient with Chronic Rhinosinusitis and Nasal Polyposis – A Case Report

New Emirates Medical Journal ◽

10.2174/0250688202002022006 ◽

2020 ◽

Vol 01 ◽

Author(s):

Mohamed Abuzakouk ◽

Omar Ghorab ◽

Safieeldin Ghazala ◽

Anastasios Hantzakos

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Nasal Polyposis ◽

Symptom Relief ◽

Olfactory Dysfunction ◽

Topical Steroids ◽

Eosinophilic Asthma ◽

Sense Of Smell ◽

Nasal Sprays ◽

Oral Steroids

Introduction: To date, there is no permanent medical treatment for nasal polyposis and loss of sense of smell. Mepolizumab is an anti-IL-5 monoclonal antibody approved for the treatment of patients with eosinophilic asthma. It has been suggested that it is capable of improving olfactory dysfunction in patients with chronic rhinosinusitis and nasal polyposis. Case: We present a 35-year-old Emirati male with progressively worsening rhinosinusitis, recurring nasal polyps and total loss of sense of smell. He was treated with oral steroids, normal saline nasal sprays and all available topical steroids without significant or permanent symptom relief. He was commenced on Mepolizumab, and upon receiving the 4th dose, he reported full recovery of his sense of smell. Conclusion: Mepolizumab appears to be very effective in treating loss of sense of smell. Further studies should be conducted to assess the efficacy and effectiveness of Mepolizumab in patients with chronic rhinosinusitis, nasal polyposis and anosmia.

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Nasal Polyps and Chronic Rhinosinusitis

Asthma ◽

10.1093/med/9780199918065.003.0021 ◽

2014 ◽

pp. 279-287

Author(s):

Hae-Sim Park ◽

Mario Sánchez-Borges ◽

Seung Youp Shin ◽

Marek L. Kowalski

Keyword(s):

Chronic Rhinosinusitis ◽

Medical Management ◽

Nasal Polyps ◽

Strong Association ◽

Asthma Severity ◽

Treatment Modalities ◽

Future Research ◽

Inadequate Response ◽

Eosinophilic Inflammation ◽

Asthma Outcomes

Chronic rhinosinusitis (CRS) and nasal polyp (NP) are major comorbid conditions of bronchial asthma. CRS with NP (CRSwNP) occurs in the setting of CRS characterized by TH2 and eosinophilic inflammation. Therefore, CRSwNP is considered an entity separate from CRS without NP (CRSsNP). Previous studies demonstrated a strong association between asthma and CRS, and patients with asthma and CRS are more likely to have NP. The presence of CRSwNP can increase asthma severity, and effective medical management can improve asthma outcomes, including overall lung function and asthma control, and drug requirements. Surgery should be reserved for select patients with inadequate response to medical management or medication intolerance or side effects. Future research may further elucidate the pathophysiology of CRS and NP, which may in turn lead to development of more effective treatment modalities.

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