Does mepolizumab treatment reduce the need for surgery in adults with severe nasal polyposis?

Treatment with mepolizumab (Nucala) reduces the need for repeat surgery in adults with severe recurrent nasal polyposis recalcitrant to intranasal or systemic steroids. (LOE = 1b)

Bachert C, Sousa AR, Lund VJ, et al. Reduced need for surgery in severe nasal polyposis with mepolizumab: randomized trial. J Allergy Clin Immunol 2017;140(4):1024-1031.  [PMID:28687232]

Randomized controlled trial (double-blinded)

Industry

Concealed

Outpatient (specialty)

Intranasal and systemic corticosteroids are the mainstays of treatment for nasal polyposis, with surgery reserved for patients who do not respond to medical treatment. These investigators identified adults, aged 18 to 70 years, with severe recurrent bilateral nasal polyposis, defined as being refractory to intranasal steroids or oral steroids for 3 or more months and with a history of at least one previous nasal polyp removal surgery. Eligible patients (N = 107) who met a defined criteria for repeat surgery (including an endoscopic nasal polyp score and a nasal polyposis severity visual analog scale [VAS] score) randomly received (concealed allocation assignment) an intravenous infusion of mepolizumab 750 mg every 4 weeks for 6 doses or matched placebo. Intranasal steroids were continued throughout the study period. Individuals who assessed outcomes remained masked to treatment group assignment. Follow-up occurred for 98.1% of patients at 25 weeks. Using intention-to-treat analysis, significantly more patients in the mepolizumab group than in the placebo group no longer met the criteria for repeat surgery at week 25 (30% vs 10%; number needed to treat = 5.0; 95% CI 2.9 - 19.5). In addition, the mepolizumab group had improvement in VAS symptom scores, nasal polyp scores, and individual symptom scores (rhinorrhea, mucus in throat, nasal blockage, and loss of smell). No serious adverse events occurred, and study discontinuation rates due to treatment-related adverse events were similar between the 2 groups.