Sinonasal and respiratory outcomes of eosinophilic granulomatosis with polyangiitis patients receiving 100 mg mepolizumab in real-life clinical practice: 1-year follow up study

Abstract

Background: Mepolizumab 300 mg is an approved treatment option for patients with eosinophilic granulomatosis with polyangiitis (EGPA), yet, the adequacy of 100 mg of mepolizumab in disease control is controversial.

Objective: To evaluate the sinonasal and respiratory outcomes of EGPA patients treated with 100 mg mepolizumab for one year.

Methods: Evaluations of 11 patients were made of the sinonasal outcome test (SNOT-22) (nasal, otologic, sleep, and emotional domains), asthma control test (ACT), forced expiratory volume in 1 s (FEV1), blood eosinophil counts and oral steroid doses before mepolizumab treatment (T0) and at the 6^th (T6) and 12^th (T12) months.

Results: A significant decrease was observed in the total SNOT-22 scores in the 6^th month, after which the scores continued to be stable until the 12^th month. (SNOT-22 median (IQR); T0: 70(53-82); T6: 19(4-35); T12: 11(6-40); T0-T6, p = 0.02; T6-T12, p = 0.85). In the subdomains of SNOT-22, nasal and sleep-related domains improved significantly in the first 6 months, and the otologic and emotional domains only improved from baseline in the 12^th month. There was a significant decrease in blood eosinophil counts in the 6^th month and oral steroid dose in the 12th month (eosinophils, median(IQR), T0: 1000(700-1800), T6: 100(0-200), p = 0.02; OCS dose, median(IQR), T0: 16(8-16); T6: 4(0-4); T12: 0(0-4); T0-T12, p = 0.002). A significant improvement was observed in ACT values in the 6^th month (ACT median (IQR); T0:16(8-18); T6: 22(21-25); p = 0.01).

Conclusion: Mepolizumab 100 mg provided a significant decrease in SNOT-22 values, especially in nasal and sleep domains, eosinophil counts and OCS dose in the 6^th month.

Keywords:

• Anti-IL5 therapy
• asthma control
• chronic rhinosinusitis
• Churg-Strauss sendrome
• corticosteroid dose
• EGPA
• eosinophils
• mepolizumab
• severe asthma
• SNOT22

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Contributions

E.D. and O.K. conceived of the presented idea, O.C.B, E.D. G.T, M.C., contributed to sample preparation. O.C.B. took the lead in writing the manuscript. A.F.K, E.D., O.K and G.K. contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.

Funding

The author(s) reported there is no funding associated with the work featured in this article.