Mepolizumab reduces need for surgery in adults with severe nasal polyposis
Clinical Question
Does mepolizumab treatment reduce the need for surgery in adults with severe nasal polyposis?
Bottom Line
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)
Reference
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]
Study Design
Randomized controlled trial (double-blinded)
Funding
Industry
Allocation
Concealed
Setting
Outpatient (specialty)
Synopsis
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.
Mepolizumab reduces need for surgery in adults with severe nasal polyposisis the Evidence Central Word of the day!
Citation
Barry, Henry, et al., editors. "Mepolizumab Reduces Need for Surgery in Adults With Severe Nasal Polyposis." EE+ POEM Archive, John Wiley & Sons, 2025. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314412/all/Mepolizumab reduces need for surgery in adults with severe nasal polyposis.
Mepolizumab reduces need for surgery in adults with severe nasal polyposis. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2025. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314412/all/Mepolizumab reduces need for surgery in adults with severe nasal polyposis. Accessed March 16, 2025.
Mepolizumab reduces need for surgery in adults with severe nasal polyposis. (2025). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314412/all/Mepolizumab reduces need for surgery in adults with severe nasal polyposis
Mepolizumab Reduces Need for Surgery in Adults With Severe Nasal Polyposis [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2025. [cited 2025 March 16]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314412/all/Mepolizumab reduces need for surgery in adults with severe nasal polyposis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Mepolizumab reduces need for surgery in adults with severe nasal polyposis
ID - 1314412
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314412/all/Mepolizumab reduces need for surgery in adults with severe nasal polyposis
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -