Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a challenging inflammatory syndrome that is often associated with eosinophilia. Abrogation of tissue eosinophils through IL-5 antagonism represents a plausible approach in the treatment of this refractory disease. We describe the effect of reslizumab, a humanized IL-5 blocker, in patients with recalcitrant CRSwNP.
Retrospective review of three consecutive patients receiving reslizumab (3mg/kg IV Q4W) for the treatment of refractory eosinophilic CRSwNP with peripheral eosinophilia (≥400cells/μL). Outcomes included validated endoscopic nasal polyp and quality-of-life scores following two infusions of reslizumab.
Mean treatment duration was 8 weeks. Presumed underlying ASA intolerance was established in all three patients by clinical history. All patients had concomitant moderate to severe asthma, and mean baseline eosinophil count was 876 cells/μL. All patients had undergone polypectomy on at least one occasion. After 8 weeks, a significant reduction of the Lund Kennedy polyp score of at least 1 point was found in all three of the patients. Mean polyp score improved from 8.6 to 4. Decreased SNOT-22 scores were observed in all patients, with mean improvement from 62 to 33. None of the patients required interval oral steroids for rescue of breakthrough nasal symptoms. No adverse events were reported secondary to reslizumab therapy.
Reslizumab may be an effective adjunctive therapy for recalcitrant CRSwNP with peripheral eosinophilia. Additional prospective study with longer follow-up may be required to unmask the full effects of reslizumab.