Mepolizumab lowers repeat surgery risk for CRSwNP regardless of number of past surgeries

Key takeaways:

• Outcomes improved with mepolizumab regardless of one or more past surgeries.
• For surgery risk and oral corticosteroid odds, the decrease with mepolizumab was larger among those with one past surgery.

SAN DIEGO — Among patients with previous sinus surgery for chronic rhinosinusitis with nasal polyps, the number of past surgeries did not alter the benefits of mepolizumab on nasal polyp and VAS scores, according to a presentation here.

This study was presented at the 2025 American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress.

As Healio previously reported, patients with previous sinus surgery for severe CRSwNP experienced less risk for further surgery while taking mepolizumab (Nucala, GSK) compared with placebo in the randomized, double-blind, placebo-controlled, parallel-group phase 3 SYNAPSE trial.

Using data from this trial, Laura Walrave, PhD, MS, BPharm, global medical director of CRSwNP at GSK, and colleagues evaluated 407 patients with at least one previous sinus surgery for CRSwNP to determine if the number of prior nasal polyp surgeries changes the impact of 100 mg subcutaneous mepolizumab (n = 206) vs. placebo (n = 201) every 4 weeks on nasal polyp score, VAS scores, time to first surgery and odds for an oral corticosteroid course at week 52.

Within the total cohort, 189 patients (108 assigned mepolizumab; 81 assigned placebo) only had one previous surgery, whereas the remaining 218 patients (98 assigned mepolizumab; 120 assigned placebo) had more than one.

When analyzing nasal polyps scores, researchers observed a significant improvement between baseline and week 52 with mepolizumab vs. placebo among those with only one previous surgery (mean change, –0.71; P = .002). This result was also true among those with more than one previous surgery (mean change, –0.84; P < .001).

At the 52-week mark, patients receiving mepolizumab vs. placebo in the group with one previous surgery had significant improvements in three VAS scores: nasal obstruction VAS (mean change, –1.52; P = .002), smell VAS (–1.37; P = .006) and overall symptom VAS (–1.5; P = .002). According to researchers, the same outcome was reached with mepolizumab in the group with more than one previous surgery when examining the change from baseline to week 52 in nasal obstruction VAS score (mean change, –1.82; P < .001), smell VAS score (–1.31; P = .001) and overall symptom VAS score (–1.88; P < .001).

Between baseline and week 52, the Sino-Nasal Outcome Test-22 score also significantly improved among those receiving mepolizumab vs. placebo regardless of the number of previous surgeries (mean change, one past surgery = –14; more than one past surgery = –13.01; both P < .001).

Researchers reported a decrease in the risk for time to first surgery with mepolizumab vs. placebo in both past surgery groups, but the reduction was larger and significant among those with only one previous surgery (73%; HR = 0.27; 95% CI, 0.1-0.69) compared with those with more than one previous surgery (39%; HR = 0.61; 95% CI, 0.3-1.23).

Similar to above, the likelihood for at least one oral corticosteroid course went down with mepolizumab vs. placebo in both surgery groups but was larger and reached significance among patients with one past surgery (OR = 0.37; 95% CI, 0.18-0.76) vs. more than one past surgery (OR = 0.94; 95% CI, 0.49-1.79), according to the abstract.

“Mepolizumab significantly improves outcomes in patients with CRSwNP with one or multiple prior [nasal polyp] surgeries, with more pronounced benefits in surgery risk and OCS use in patients with one prior surgery,” Walrave and colleagues wrote.

Reference:

• Mepolizumab reduces need for repeat sinus surgeries in patients with chronic rhinosinusitis with nasal polyps. https://www.aaaai.org/about/news/news/2025/mepolizumab. Published Feb. 10, 2025. Accessed Feb. 10, 2025.