Evaluation of ongoing mepolizumab treatment in chronic rhinosinusitis with nasal polyps

Ludger Klimek; Ulrike Förster-Ruhrmann; Heidi Olze; Achim G. Beule; Adam M. Chaker; Jan Hagemann; Tilmann Huppertz; Thomas K. Hoffmann; Stefan Dazert; Thomas Deitmer; Sebastian Strieth; Holger Wrede; Wolfgang Schlenter; Hans-Jürgen Welkoborsky; Barbara Wollenberg; Sven Becker; Frederike Bärhold; Felix Klimek; Ingrid Casper; Jaron Zuberbier; Claudia Rudack; Mandy Cuevas; Constantin A. Hintschich; Orlando Guntinas-Lichius; Timo Stöver; Christoph Bergmann; Pascal Werminghaus; Oliver Pfaar; Jan Gosepath; Moritz Gröger; Caroline Beutner; Martin Laudien; Rainer K. Weber; Tanja Hildenbrand; Anna-Sophie Hoffmann; Claus Bachert

doi:10.37349/eaa.2024.00027

Exploration of Asthma & Allergy ›› 2024, Vol. 2 ›› Issue (1) :33 -48. DOI: 10.37349/eaa.2024.00027

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Evaluation of ongoing mepolizumab treatment in chronic rhinosinusitis with nasal polyps

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¹ Center for Rhinology and Allergology, 65183 Wiesbaden, Germany

² Department of Otorhinolaryngology, Charité — Universitätsmedizin Berlin, 10117 Berlin, Germany

³ Department of Otorhinolaryngology, Münster University Hospital, 48149 Münster, Germany

⁴ Department of Otorhinolaryngology, Head and Neck Surgery of Greifswald University Medical Center, 17475 Greifswald, Germany

⁵ Department of Otorhinolaryngology, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany

⁶ Center for Allergy and Environment (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany

⁷ Department of Otorhinolaryngology, Mainz University Medical Center, 55131 Mainz, Germany

⁸ Department of Otorhinolaryngology, Ulm University Hospital, 89081 Ulm, Germany

⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth Hospital, 44787 Bochum, Germany

¹⁰ German Society for Otorhinolaryngology, Head and Neck Surgery, 53113 Bonn, Germany

¹¹ Clinic and Polyclinic for Otorhinolaryngology, Bonn University Hospital, 53127 Bonn, Germany

¹² Ear, Nose and Throat Specialist, 32052 Herford, Germany

¹³ Medical Association of German Allergists, 65183 Wiesbaden, Germany

¹⁴ Clinic for Otorhinolaryngology, Hanover Hospital, 30167 Hannover, Germany

¹⁵ Department of Otorhinolaryngology, University Hospital Tübingen, 72016 Tübingen, Germany

¹⁶ Clinic and Polyclinic for Otorhinolaryngology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany

¹⁷ Clinic and Polyclinic for Otorhinolaryngology, University Hospital Regensburg, 93053 Regensburg, Germany

¹⁸ Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany

¹⁹ Frankfurt University Ear, Nose and Throat Clinic, 60596 Frankfurt am Main, Germany

²⁰ Practice for Otorhinolaryngology, Clinic RKM 740, 40549 Düsseldorf, Germany

²¹ Practice for Ear, Nose and Throat Medicine and Allergology, 40476 Düsseldorf, Germany

²² Department of Otorhinolaryngology, University Hospital Giessen and Marburg GmbH, Marburg site, Philipps University Marburg, 35037 Marburg, Germany

²³ Department of Otorhinolaryngology, HSK Wiesbaden, 65199 Wiesbaden, Germany

²⁴ Clinic and Polyclinic for Otorhinolaryngology, LMU University Hospital, 80336 Munich, Germany

²⁵ Clinic for Dermatology, Venereology and Allergology, Allergy Center South Lower Saxony, University Medical Center Göttingen, 37075 Göttingen, Germany

²⁶ Department of Otorhinolaryngology, Kiel University Hospital, 24105 Kiel, Germany

²⁷ Department of Otorhinolaryngology, Karlsruhe Municipal Hospital, 76133 Karlsruhe, Germany

²⁸ Department of Otorhinolaryngology, University Medical Center Freiburg, 79106 Freiburg, Germany

²⁹ Department of Otorhinolaryngology, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany

³⁰ Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium

^*Ludger Klimek, Center for Rhinology and Allergology, An den Quellen 10, 65183 Wiesbaden, Germany.Ludger.Klimek@Allergiezentrum.org

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Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and paranasal sinuses. Eosinophilic inflammation is described as a common endotype. The anti-interleukin-5 (IL-5) antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe CRSwNP when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, therapy monitoring and follow-up documentation are required, and therapy discontinuation has not been adequately established yet. In this paper, recommendations for monitoring the course and efficacy of therapy as well as for reviewing the duration and possible termination of therapy are provided. For this purpose, a literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching MEDLINE, PubMed, and the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including October 2022 were considered. Based on the international literature and previous experience, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given by an expert panel on the basis of a documentation sheet.

Keywords

Chronic rhinosinusitis / chronic rhinosinusitis with nasal polyps / biologics / eosinophilic inflammation / mepolizumab

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Ludger Klimek, Ulrike Förster-Ruhrmann, Heidi Olze, Achim G. Beule, Adam M. Chaker, Jan Hagemann, Tilmann Huppertz, Thomas K. Hoffmann, Stefan Dazert, Thomas Deitmer, Sebastian Strieth, Holger Wrede, Wolfgang Schlenter, Hans-Jürgen Welkoborsky, Barbara Wollenberg, Sven Becker, Frederike Bärhold, Felix Klimek, Ingrid Casper, Jaron Zuberbier, Claudia Rudack, Mandy Cuevas, Constantin A. Hintschich, Orlando Guntinas-Lichius, Timo Stöver, Christoph Bergmann, Pascal Werminghaus, Oliver Pfaar, Jan Gosepath, Moritz Gröger, Caroline Beutner, Martin Laudien, Rainer K. Weber, Tanja Hildenbrand, Anna-Sophie Hoffmann, Claus Bachert. Evaluation of ongoing mepolizumab treatment in chronic rhinosinusitis with nasal polyps. Exploration of Asthma & Allergy, 2024, 2 (1) : 33-48 DOI:10.37349/eaa.2024.00027

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