Real-world two-year outcomes of mepolizumab in patients with chronic rhinosinusitis with nasal polyps and coexisting severe asthma.

purposeChronic rhinosinusitis with nasal polyps (CRSwNP) and severe asthma frequently coexist as manifestations of type 2 airway inflammation. Although mepolizumab has demonstrated efficacy in both conditions, long-term real-world data on integrated airway disease control remain limited. We evaluated the long-term effectiveness of mepolizumab in patients with CRSwNP and coexisting severe asthma over 2 years.

methodsWe conducted a longitudinal real-world observational cohort study at a tertiary referral center. Baseline data were collected retrospectively, and follow-up assessments were prospectively recorded at 6, 12, and 24 months. Response-based endpoints assessed longitudinal improvement, whereas disease control reflected stabilization of disease burden at each follow-up, including dual airway disease control.

results48 patients were included. Mepolizumab induced sustained improvement across both airway compartments. SNOT-22 scores improved from 65.2 to 22.1, while NPS decreased from 4.8 to 1.8 at 2 years. ACT scores increased from 16.6 to 22.7, exacerbation rates decreased from 0.7 to 0.1 events per patient-year, and systemic corticosteroid exposure decreased from 95.8% to 31%. Combined clinical-endoscopic CRSwNP response was achieved in 60.0%, 75.0%, and 70.6% at 6 months, 1 year, and 2 years, respectively. Dual airway disease control increased from 24.2% to 42.1%.

conclusionsMepolizumab provides sustained long-term benefit in patients with CRSwNP and severe asthma. While clinical response occurs early and frequently, integrated dual airway disease control is achieved progressively and in a smaller proportion of patients.