International forum of allergy & rhinology
May 13, 2026 · via Europe PMC
Chronic Rhinosinusitis With Nasal Polyposis in EGPA: A Real-Life Multidimensional Analysis Through Mepolizumab Dosing and Role of Adjunctive Endoscopic Sinus Surgery (ESS).
Howardson BO, Danè G, Moroni L, +7 more, Karligkiotis A.
AI summary — for doctors, generated from the abstract only
In EGPA on mepolizumab, systemic remission was common but sinonasal disease often persisted.
What was studied
Retrospective 52-patient cohort with 24 months follow-up assessing ENT scores and predictors of sinus surgery.
Key findings
- Systemic remission in over 90%; eosinophils fell from median 700 to 59.5 cells/µL
- Polyps persisted in 64% and mucosal edema/discharge in 92%
- 28.8% had adjunctive ESS; more surgery linked to higher baseline burden and prior surgery
Clinical relevance
Suggests combined ENT assessment alongside systemic markers.
Who should care
Limitations
Small retrospective cohort; regimen comparisons confounded.
Systemic control does not guarantee sinus control.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare necrotizing vasculitis involving upper- and lower-airways. Despite biologics, sinonasal disease often persists. Evidence on ENT trajectories under anti-IL5 treatment and role of endoscopic sinus surgery (ESS) remains limited and is often described without standardized assessment tools. This study provides a systematic, multidimensional evaluation of sinonasal outcomes under biologic therapy and analyzes the role of ESS in a real-life cohort.
Methods
We retrospectively analyzed 52 EGPA patients with a 24-month follow-up on mepolizumab. Sinonasal disease was assessed by Nasal Polyp Score (NPS), Lund-Kennedy Score (LKS), Lund-Mackay score (LMK), and SNOT-22, while systemic activity was assessed by Birmingham Vasculitis Activity Score (BVAS). Patients were stratified by mepolizumab regimen (100 mg, 300 mg, and step-down). Predictors of adjunctive ESS were explored through multivariate logistic regression.
Results
Systemic remission occurred in >90% of patients, with marked eosinophil suppression (median 700 → 59.5 cells/µL) and BVAS = 0. Conversely, NPS and LKS remained stable [IQR]: (NPS 4 [3-5] → 4 [2-5]; LKS 6 [4-8] → 5 [2-7.75]. Polyps persisted in 64% and mucosal edema/discharge in 92% of population. Continuous 100 mg therapy showed the greatest endoscopic improvement. Higher baseline sinonasal burden, more extensive surgical history, and mepolizumab dose variation were associated with adjunctive ESS (28.8%), whereas BVAS and eosinophils showed no correlation with ENT severity.
Conclusion
Sinonasal disease may persist despite systemic remission, suggesting a partially independent inflammatory niche. Comprehensive assessment should combine systemic markers with dedicated ENT evaluation, while management may require integrated biologic-surgical strategies in chronic structural disease.
DOI
10.1002/alr.70184
PMID
42838758
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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