D1.114 - Efficacy of Radical Endoscopic Surgery Combined with Mepolizumab in Chronic Rhinosinusitis with Nasal Polyps Complicated with Bronchial Asthma: A Real-World research

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often comorbid with bronchial asthma (BA), and the two conditions share a core pathological mechanism centered on type 2 inflammatory response, particularly interleukin-5 (IL-5) mediated eosinophilia. Although glucocorticoids and surgical intervention are conventional therapies for CRSwNP complicated with BA, some patients still suffer from recurrent symptoms, drug dependence and postoperative recurrence. As a monoclonal antibody targeting IL-5, mepolizumab has been demonstrated significant efficacy in severe eosinophilic asthma, yet its therapeutic efficacy and clinical value combined with radical endoscopic surgery for refractory CRSwNP complicated with BA still need to be further verified.

This study enrolled 15 patients with CRSwNP complicated by BA from the Department of Otolaryngology, the First Affiliated Hospital and Sun Yat-sen Memorial Hospital of Sun Yat-sen University, and collected and analyzed their real world data. The main treatment was radical endoscopic surgery combined with mepolizumab. The primary outcome measures included preoperative nasal polyp score, preoperative Asthma Control Questionnaire (ACQ-5) score, allergen profile, preoperative nasal symptom score, preoperative peripheral blood eosinophil count and proportion, preoperative sinus CT score, as well as postoperative changes in patients symptom scores, asthma control, and the improvement and maintenance status of olfactory function.

The radical endoscopic surgery combined with one-year mepolizumab treatment can significantly improve the symptoms and quality of life of patients with refractory CRSwNP complicated by BA, with simultaneous benefits achieved in both the upper and lower airways. The maintenance of olfactory function also brings long-term benefits to patients. In addition, mepolizumab treatment reduces the peripheral blood eosinophil count without increasing the incidence of adverse events.

The radical endoscopic surgery combined with mepolizumab treatment can rapidly reduce patients’ inflammatory burden, effectively improve and sustain long-term olfactory function, asthma control and airway obstruction in patients with CRSwNP with BA, with favorable safety profile. This study supports its use as a novel therapeutic option for type 2 inflammatory comorbidities, especially suitable for patients with eosinophilic phenotype.