Mepolizumab Shows Real-World Gains in Severe Nasal Polyps
A real-world Italian study found that mepolizumab significantly reduced nasal polyp scores and improved quality of life in adults with severe chronic rhinosinusitis with nasal polyps. At 12 months, 42% achieved disease control and 20% were on track for remission. Researchers suggest benefits may continue beyond the study period.
The study tracked 621 patients across 25 Italian rhinology clinics, with a median age of 59 and a slight male majority. Over half had comorbid asthma, and nearly a third had NSAID-exacerbated respiratory disease. About 18% had previously used another biologic, mostly dupilumab, before switching to mepolizumab.
Nasal polyp scores fell from a median of 6 to 3 on the 8-point scale, while SNOT-22 quality-of-life scores improved from 59 to 21. However, 38% of patients with available data still could not smell at 12 months. The researchers noted that improvements appeared progressive, suggesting benefits might extend beyond the study window.
This real-world evidence could help clinicians make more informed decisions about biologic therapy sequencing for severe nasal polyps. Patients who have not responded to surgery or other treatments may benefit from clearer expectations about mepolizumab's trajectory, including the possibility of remission. The finding that 20% of patients were approaching remission suggests that longer treatment courses might yield better outcomes, potentially influencing insurance coverage decisions and treatment duration guidelines. However, the persistent smell loss in over a third of patients highlights that not all symptoms respond equally.