Disconnect between effects of mepolizumab on severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps

Chan, Rory; Kuo, Chris RuiWen; Lipworth, Brian J.

doi:10.1016/j.jaip.2020.01.009

Cited by 32 publications

(25 citation statements)

References 9 publications

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“…However, the effect of mepolizumab in the management of CRSwNP is still unclear. Some reports have raised concerns about its real effectiveness for CRSwNP outcomes [25, 26]. Our results are in line with previous reports in the literature: in particular, a post hoc analysis of the MUSCA study demonstrated a significant decrease in SNOT22 values after 24 weeks of treatment, reporting a mean score reduction similar to ours (11.8 vs. 13.1) [27].…”

Section: Discussionsupporting

confidence: 92%

A Comprehensive Evaluation of Mepolizumab Effectiveness in a Real-Life Setting

Cameli

Bergantini

d’Alessandro

et al. 2020

Int Arch Allergy Immunol

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Introduction: Interleukin-5 (IL-5) is the principal cytokine regulating eosinophil growth, differentiation, activation, and expression. It is a specific target of mepolizumab, an anti-IL-5 monoclonal antibody used in the treatment of severe eosinophilic asthma. This new drug can improve symptoms, reduce asthma exacerbations and steroid use. Few data are available on its efficacy for nasal symptoms. Objective: To describe the all-round clinical impact of mepolizumab in a real-life setting, evaluating the efficacy and safety of the drug in severe eosinophilic asthma patients. Population and Methods: We retrospectively collected the clinical and functional data on 27 patients (16 males) affected with severe eosinophilic asthma, diagnosed at the Siena Regional Referral Centre and monitored for 6 months. Clinical, immunological, and functional data at baseline and follow-up were entered in a database together with comorbidities, number of exacerbations, steroid treatment, multiple-flow exhaled nitric oxide, and validated questionnaires. Results: A significant reduction in asthma exacerbations was observed in all patients after 6 months of the biological therapy (p = 0.0009), and 4/6 patients discontinued chronic oral steroids. A significant improvement in ACT, FEV1, SNOT22, and alveolar nitric oxide was observed after 1 month of mepolizumab (p = 0.003, p = 0.007, p = 0.047, and p = 0.019, respectively) and maintained after 6 months of treatment. After 6 months, FeNO 50 was reduced as well (p = 0.030). Mepolizumab was very well tolerated, and no major side effects were observed. Conclusions: Our study suggests that mepolizumab is effective in improving control of asthma, lung function parameters, exhaled biomarkers, and nasal symptoms in patients with severe eosinophilic asthma.

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Section: Discussionsupporting

confidence: 92%

A Comprehensive Evaluation of Mepolizumab Effectiveness in a Real-Life Setting

Cameli

Bergantini

d’Alessandro

et al. 2020

Int Arch Allergy Immunol

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“…Lipworth et al questioned the findings, because this did not concord with their personal experience with mepolizumab in 6 patients. 6 We are sure, however, that the authors would not contest that a large prospective formally conducted placebo-controlled clinical trial is more substantial than an anecdotal case report. Nevertheless, they reported a disparity of effect with mepolizumab within the upper and lower airways in their subjects.…”

Section: Replymentioning

confidence: 99%

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Howarth¹,

Bachert

Chan

2020

Journal of Allergy and Clinical Immunology

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“…We thank Lipworth et al 1 for their correspondence about our recent publication, 2 within which they acknowledge that studies with mepolizumab in chronic rhinosinusitis with nasal polyposis (CRSwNP) have shown benefit in reducing nasal polyp size. 3,4 They, however, question the 22-item Sino-Nasal Outcome Test (SNOT-22) findings from the MUSCA 5 study, a placebo-controlled study of mepolizumab in 551 participants with severe eosinophilic asthma of whom 19% (n 5 105) reported nasal polyps at screening. The analysis of the SNOT-22 outcome found that mepolizumab significantly improved this upper airway outcome measure compared with placebo in those with this history of CRSwNP.…”

Section: Replymentioning

confidence: 99%

“…We have reported a series of patients with severe eosinophilic asthma in whom mepolizumab given subcutaneously improved asthma control while suppressing blood eosinophils from a mean of 1393 to 120 cells/mL. 3 In contrast, in these patients with a mean baseline Lund-Mackay score of 21/24, mepolizumab had no impact on CRSwNP exacerbations requiring corticosteroids, endoscopic nasal polyp score, or persistent anosmia. Indeed, Laidlaw et al 4 reported a disconnect between depletion of blood and tissue eosinophils with dexpramipexole over 6 months with no change in polyp size or improvement in symptoms.…”

mentioning

confidence: 97%