Abstract
Purpose
Chronic rhinosinusitis with nasal polyps (CRSwNP) and severe asthma frequently coexist as manifestations of type 2 airway inflammation. Although mepolizumab has demonstrated efficacy in both conditions, long-term real-world data on integrated airway disease control remain limited. We evaluated the long-term effectiveness of mepolizumab in patients with CRSwNP and coexisting severe asthma over 2 years.Methods
We conducted a longitudinal real-world observational cohort study at a tertiary referral center. Baseline data were collected retrospectively, and follow-up assessments were prospectively recorded at 6, 12, and 24 months. Response-based endpoints assessed longitudinal improvement, whereas disease control reflected stabilization of disease burden at each follow-up, including dual airway disease control.Results
48 patients were included. Mepolizumab induced sustained improvement across both airway compartments. SNOT-22 scores improved from 65.2 to 22.1, while NPS decreased from 4.8 to 1.8 at 2 years. ACT scores increased from 16.6 to 22.7, exacerbation rates decreased from 0.7 to 0.1 events per patient-year, and systemic corticosteroid exposure decreased from 95.8% to 31%. Combined clinical-endoscopic CRSwNP response was achieved in 60.0%, 75.0%, and 70.6% at 6 months, 1 year, and 2 years, respectively. Dual airway disease control increased from 24.2% to 42.1%.Conclusions
Mepolizumab provides sustained long-term benefit in patients with CRSwNP and severe asthma. While clinical response occurs early and frequently, integrated dual airway disease control is achieved progressively and in a smaller proportion of patients.