Chronic Rhinosinusitis With Nasal Polyposis in EGPA: A Real-Life Multidimensional Analysis Through Mepolizumab Dosing and Role of Adjunctive Endoscopic Sinus Surgery (ESS)

IF 4.9 2区医学 Q1 OTORHINOLARYNGOLOGY

International Forum of Allergy & Rhinology Pub Date : 2026-10-04 Epub Date: 2026-05-13 DOI:10.1002/alr.70184

Bright Oworae Howardson, Giulia Danè, Luca Moroni, Marco Lanzillotta, Umberto Tanzini, Gabriele D. Gallina, Adriana Cariddi, Biancamaria Venerandi, Lorenzo Dagna, Leone Giordano, Apostolos Karligkiotis

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引用次数: 0

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.

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EGPA慢性鼻窦炎伴鼻息肉：Mepolizumab给药和辅助内镜鼻窦手术（ESS）作用的现实多维分析

背景嗜酸性肉芽肿病合并多血管炎（EGPA）是一种罕见的累及上、下气道的坏死性血管炎。尽管使用了生物制剂，鼻窦疾病仍然存在。抗il - 5治疗和内窥镜鼻窦手术（ESS）作用下耳鼻喉发育轨迹的证据仍然有限，并且通常没有标准化的评估工具。本研究对鼻窦生物治疗的结果进行了系统、多维度的评估，并分析了ESS在现实生活中的作用。方法回顾性分析52例EGPA患者，对mepolizumab进行了24个月的随访。采用鼻息肉评分（NPS）、隆德-肯尼迪评分（LKS）、隆德-麦凯评分（LMK）和SNOT-22评估鼻窦疾病，采用伯明翰血管炎活动评分（BVAS）评估全身活动性。根据mepolizumab方案（100mg， 300mg和降压）对患者进行分层。通过多元逻辑回归探讨辅助ESS的预测因素。结果90%的患者出现全身缓解，嗜酸性粒细胞明显抑制（中位值700→59.5细胞/µL）， BVAS = 0。相反，NPS和LKS保持稳定[IQR]: (NPS 4[3-5]→4 [2-5];LKS 6[4 - 8]→5[2-7.75]。息肉持续发生率为64%，粘膜水肿/分泌物发生率为92%。持续100毫克治疗显示最大的内镜改善。较高的基线鼻窦负担、更广泛的手术史和mepolizumab剂量变化与辅助性ESS相关（28.8%），而BVAS和嗜酸性粒细胞与耳鼻喉严重程度无关。结论鼻窦炎虽有全身缓解，但仍可能持续存在，提示存在部分独立的炎症生态位。综合评估应结合系统标志物和专门的耳鼻喉科评估，而慢性结构性疾病的管理可能需要综合的生物外科策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Forum of Allergy & Rhinology OTORHINOLARYNGOLOGY-

CiteScore

11.70

自引率

10.90%

发文量

185

审稿时长

6-12 weeks

期刊介绍： International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.