A multidimensional approach to 12-month response to mepolizumab in severe chronic rhinosinusitis with nasal polyps: a real-world single-centre study.

BACKGROUND: Although randomized clinical trials have demonstrated the efficacy of mepolizumab in severe CRSwNP, treatment response in routine clinical practice extends beyond sinonasal outcomes alone and often requires simultaneous assessment of symptom burden, asthma control, and eosinophilic inflammation. Real-world multidimensional evaluations remain limited. AIMS/OBJECTIVES: To evaluate the 12-month clinical response to mepolizumab in patients with severe, uncontrolled CRSwNP using a structured multidimensional assessment framework. MATERIALS AND METHODS: This retrospective single-centre real-world study included adult patients with severe, uncontrolled CRSwNP treated with mepolizumab. All patients had ≥2 prior endoscopic sinus surgeries and evidence of type 2 inflammation. Response at 12 months was evaluated across five domains: endoscopic findings, quality of life, nasal symptoms, olfactory symptoms, and asthma control and absence of systemic corticosteroid use. Overall response was classified as excellent response, partial response, or no response. Changes in Nasal Polyp Score (NPS), SNOT-22, visual analogue scale (VAS) scores, Asthma Control Test (ACT), and blood eosinophils were analysed. RESULTS: Ten patients were included. Improvements were observed in NPS (5.3 to 2.7; p=0.008), SNOT-22 (63.9 to 34.6; p=0.004), nasal VAS (7.0 to 4.3; p=0.047), olfactory VAS (9.0 to 5.9; p=0.008), ACT (16.2 to 21.2; p=0.047), and eosinophils (502.2 to 77.0 cells/µL; p=0.004). According to the revised multidimensional assessment framework, 5 patients (50%) achieved an excellent response and 5 patients (50%) achieved a partial response. One patient required rescue systemic corticosteroids during follow-up. No patients fulfilled the predefined criteria for non-response. CONCLUSIONS: In this small real-world cohort, mepolizumab was associated with improvement across multiple clinically relevant domains in patients with severe CRSwNP. These findings should be considered exploratory and require confirmation in larger prospective studies.