A pragmatic analysis of mepolizumab in patients with aspirin-exacerbated respiratory disease
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Katherine L. Tuttle, MD, Kathleen M. Buchheit, MD, Thomas Schneider, BA, Karen S. Hsu Blatman, MD, Nora A. Barrett, MD FAAAAI, Tanya M. Laidlaw, MD FAAAAI, Katherine N. Cahill, MD
RATIONALE: Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome defined by chronic eosinophilic rhinosinusitis, nasal polyposis, asthma, and upper and lower respiratory reactions after exposure to cyclooxygenase-1 inhibitors. Previous studies have shown that nasal polyps from patients with AERD have significantly higher eosinophil burden than those from aspirin-tolerant controls and mepolizumab has been shown to reduce polyp size in patients with eosinophilic nasal polyposis. Anti-interleukin 5 (IL-5) therapeutics, such as mepolizumab, are available for severe eosinophilic asthma but have not been formally evaluated in AERD. We aimed to determine the clinical effect of mepolizumab on upper and lower airway symptoms in AERD.

METHODS: Asthma control test (ACT) and sino-nasal outcome test (SNOT-22) scores from fourteen patients with AERD treated at the Brigham and Women’s Hospital AERD Center were retrospectively compared before initiation of mepolizumab and after at least 3 doses of mepolizumab (100mg every four weeks). Wilcoxon signed-rank test was used to compare data.

RESULTS: Treatment with mepolizumab for three or more doses significantly reduced SNOT-22 scores by 17.7 points (SEM 4.9, p = 0.02) and increased ACT scores by 5.1 points (SEM 1.4, p= 0.001). Mepolizumab significantly reduced patient-reported nasal congestion (p<0.03) and improved patient-reported sense of smell (p<0.03).

CONCLUSIONS: In fourteen patients with AERD, IL-5 inhibition with mepolizumab for at least 3 months significantly improved both upper and lower airway symptom scores and notably anosmia and nasal congestion, important quality-of-life measures for AERD patients. The benefit of mepolizumab extends beyond the lower airway and should be examined prospectively in patients with AERD.