Nasal polyps are small, non-cancerous growths that develop in the lining of the nose and sinuses. Chronic rhinosinusitis (CRS) is a condition characterized by inflammation of the nasal and sinus passages that persists for more than 12 weeks. Nasal polyps can develop as a complication of CRS, particularly in patients with severe disease. CRS with nasal polyps (CRSwNP) can cause various symptoms, including nasal congestion, runny nose, reduced sense of smell, facial pressure or pain, and postnasal drip. These symptoms can significantly impact a patient's quality of life and ability to function normally.
The exact cause of nasal polyps in CRS is not fully understood, but it is thought to be related to an abnormal immune response in the nasal and sinus tissues. This response can lead to chronic inflammation, which can trigger the growth of polyps. Treatment for CRSwNP typically involves a combination of medications, such as corticosteroids and nasal sprays, and surgery. Surgery is generally reserved for patients who do not respond to drugs or have recurrent polyps. However, even after surgery, nasal polyps can recur in up to 75% of patients with CRSwNP.
Mepolizumab, a drug that targets a specific type of white blood cell called eosinophils, has been shown to reduce the need for sinus surgery in a clinical trial called SYNAPSE. A follow-up study aimed to provide more detailed information about the effect of mepolizumab on surgery endpoints in the SYNAPSE trial. The trial included adults with recurrent, refractory, severe CRSwNP eligible for repeat sinus surgery. Patients were randomized to receive mepolizumab or a placebo and standard care every four weeks for 52 weeks.