Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a heterogeneous upper airway disease that is prevalent globally. Recent research into the molecular basis of the disease has led to the development of biologics as a new therapeutic option for severe and recalcitrant forms of CRSwNP. Mepolizumab is a monoclonal antibody targeting IL-5, one of the signature cytokines of the type 2 immune response and which plays an important role in the pathogenesis of CRSwNP. Here we present the latest evidence behind mepolizumab, examining disease pathophysiology and pharmacology, as well as data from clinical trials, real-life studies and meta-analyses. As we welcome this promising step forward into precision medicine, we discuss practical issues and future perspectives on mepolizumab and biologics for CRSwNP.
Keywords: biologics; chronic rhinosinusitis; mepolizumab; nasal polyps; type 2 inflammation; upper airway disease.
Mepolizumab is a new injectable drug developed to control difficult-to-treat cases of chronic rhinosinusitis with nasal polyposis (CRSwNP), an inflammatory disease of the nose that affects many people worldwide. It works by blocking the action of IL-5, an important protein in the body that regulates inflammation. One of the main effects of this protein is promoting the activity of eosinophils, a type of white blood cell. Eosinophils contribute to tissue damage when activated inappropriately. A recent large-scale study (SYNAPSE) on patients using this drug has been completed, reporting favorable results. In this article, we discuss the science behind the disease, the drug and data from patient studies. We conclude by discussing several future challenges and opportunities in the management of CRSwNP.