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J.K. Han - J. Mullol - M. Wagenmann - L. Walrave - L. Zhang - A.R. Sousa - P. Howarth - C. Hopkins

DOI: 10.4193/Rhin25.599

BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often undergo multiple nasal surgeries. The Phase III SYNAPSE study (GSK ID:205687; NCT0308579) demonstrated that mepolizumab reduces the need for repeat surgery. We explored
whether outcomes differed based on the number of prior surgeries.
METHODOLOGY: This post hoc analysis of SYNAPSE stratified patients by history of 1 or >1 prior surgery. Patients were randomised to receive mepolizumab or placebo every 4 weeks, alongside standard of care, for 52 weeks. Outcomes included change from baseline in endoscopic nasal polyp (NP) score, visual analogue scale (VAS) scores for nasal obstruction, loss of smell and overall symptoms, Sino-Nasal Outcome Test-22 (SNOT-22), and time to repeat surgery and/or oral corticosteroid (OCS) use.
RESULTS: 189 patients had 1 prior surgery (108 mepolizumab; 81 placebo) and 218 had >1 prior surgery (98; 120). In both subgroups, mepolizumab significantly improved mean changes versus placebo in NP, nasal obstruction, loss of smell VAS, overall symptom VAS, and SNOT-22. Significant reductions in risk of repeat surgery and requiring OCS were observed with mepolizumab versus placebo in patients with 1 prior surgery.
CONCLUSIONS: Mepolizumab improves outcomes in patients with CRSwNP with one or multiple prior surgeries; however, may offer greater benefit when initiated after a single surgery.

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