Abstract
Background: In severe eosinophilic asthma (SEA), mepolizumab, an anti-interleukin 5 (IL-5) monoclonal antibody (mAb) can reduce asthma exacerbations and oral corticosteroid (OCS) requirements, but effect on nasal polyps (NP) recurrence and need for surgery is uncertain. We aimed to study the treatment (Rx) response in SEA patients with NP (SEAwNP) and assess for predictors of suboptimal Rx response individually for the asthma and NP components. Method: We measured sputum cell counts, cytokines, autoantibodies and nasoendoscopic total polyp score (TPS) in 6 patients with SEAwNP on mepolizumab (100mcg q4weeks) over 15 months, every 3 months. Optimal Rx response to the SEA component was defined as sputum eosinophil counts ≤ 3% after 4 months of treatment and >1 of the following: a) ACT score ≥20, b) Reduction of OCS dosage by ≥50%, c) 0 exacerbation requiring an OCS burst. Rx response for NP was defined as a) reduction in TPS by ≥1, (b) no recurrence. Results: There was optimal Rx response in 3/6(50%) patients with respect to their SEA component, while only 30% for NP. The suboptimal response in SEAwNP is predicted by sputum eosinophil counts (>3%), even when asthma controlled (ACT≥20). Suboptimal response in SEA and NP is associated with rise in sputum IL-5 and IL-13 respectively; baseline levels cannot predict treatment response. IL-5 is correlated with anti-EPX antibodies (r=0.52,p=0.0026) in individual patients. However collectively, anti-EPX levels remained constant, regardless of treatment response. Conclusions: Mepolizumab has differential Rx response to the nasal polyp component in SEAwNP patients. Trends in sputum eosinophil and IL-5 and IL13 can predict suboptimal treatment response.
Published Version
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