D1.110 - Long Term Mepolizumab in Type-2 CRSwNP: Marked Polyp Reduction, Symptom Relief, and Airway Benefits in Real World Comorbid Patients

Despite biologics' promise in Type 2 chronic rhinosinusitis with nasal polyps (CRSwNP), long-term real-world data on simultaneous upper/lower airway benefits in comorbid asthma/NERD cohorts remain scarce, limiting personalized therapy optimization.

Non-consecutive adults with severe Type 2 CRSwNP (EPOS/EUFOREA criteria; NPS ≥5, prior surgery/OCS failure; mepolizumab-eligible per national funding) from Allergy/ENT clinics underwent assessment at baseline (T0) and after 18 months of mepolizumab 100 mg/4 weeks (T1). Outcomes included NPS, SNOT-22, olfactory VAS, ACT, FEV₁, blood eosinophils, IgE, and FENO.

Thirty-two highly comorbid patients (16 severe uncontrolled asthma, 10 NERD) showed large-magnitude improvements: NPS reduced 68% (5.76±1.56 to 1.83±2.07, p<0.0001); SNOT-22 improved 55% (60.7±24.9 to 27.1±20.3, p<0.0001); olfactory VAS (8.4±1.2 to 5.9±2.7, p<0.0001). Eosinophils dropped 93% (680.6±290.5 to 49.6±48.9 cells/μL, p<0.0001); asthmatics gained ACT (14.5±4.6 to 21.8±3.7, p<0.05) and FEV₁ (2530±761 to 2960±1027 mL, p<0.05). Fifteen percent (5 patients) discontinued (lack of response/adverse events).

Mepolizumab delivered sustained multidomain efficacy over 18 months in real-world severe Type 2 CRSwNP with comorbidities, markedly reducing polyp burden, symptoms, eosinophilia, and improving asthma control. These data underscore the need for personalized response monitoring to optimize long-term Type 2 airway therapy in heterogeneous cohorts.