The aim of this study was to evaluate the efficacy of mepolizumab in patients affected by chronic rhinosinusitis with nasal polyps (CRSwNP) in real-life. A single-center retrospective observational study was conducted on severe CRSwNP patients treated with mepolizumab. Nasal endoscopic polyp score (NPS), visual analogue scale (VAS) symptom score, sinonasal outcome test (SNOT-22), asthma control test (ACT) score, fractional exhaled nitric oxide (FeNO), eosinophils blood cells and prednisone intake were assessed at baseline and after 6 months. A total of 55 patients were included; 49 patients (89%) presented with asthma; aspirin exacerbated respiratory disease (AERD) in 28 patients (51%). A statistically significant decrease in the SNOT-22 score was observed (median difference −63; 95% CI: −68; −58; p < 0.001) with median t0 76 and IQR (61;90) to t6 10 (5;15). A reduction in NPS, median t0 NPS 4; (IQR:4;6), median t6 NPS 1; (IQR:0;1) p < 0.001, was greater in patients with AERD. The median baseline VAS score was 6 (IQR:6;7) and the differences between t0 and t6 were statistically significant p < 0.001. Significant changes in blood eosinophils cells, median t0 500 cell/mcl (IQR:340;830), median t6 97 cell/mcl (IQR:60;160) p < 0.001, were greater in patients with AERD. Mepolizumab treatment effects have been demonstrated with significantly reduced symptoms, polyp scores, blood eosinophils and systemic corticosteroid use, resulting in an increased health-related quality of life in patients with severe CRSwNP, regardless of the presence or absence of asthma or AERD.

Dupilumab, an anti-IL-4 receptor monoclonal antibody (mAb), was recently approved for the treatment of severe chronic rhinosinusitis with nasal polyps (CRSwNP). The main objective of this study was to assess whether previous exposure to biological treatment affected the clinical outcomes in CRSwNP and asthma patients, treated with dupilumab over time. A collateral secondary objective was to analyse the effects over time of dupilumab in patients with and without aeroallergen sensitization. Single-centre retrospective observational study on severe CRSwNP patients treated with dupilumab. Nasal polyp score (NPS), visual analogue scale (VAS) symptom score, sinonasal outcome test (SNOT-22), aeroallergen sensitization, total serum IgE levels, and blood eosinophil counts were assessed at baseline and after 4, 6 and 12 months. 42 patients were included, 40 (95.2%) had asthma. Twenty-one (50%) patients received dupilumab without prior biological treatment (Group A: naive) and 50% switched to dupilumab from previous biological treatment (Group B: pre-treated). NPS, VAS symptoms, SNOT-22 improved significantly after 12 months treatment in both groups of patients (p < 0.001). After 12 months, VAS overall symptom score showed a significant reduction from 6 (IQR, 4.6-8.6) and 6 (IQR, 3.8-7.1) for Group A and Group B patients respectively, to 1.2 (IQR, 0.8-2.7) and 1.2 (IQR, 0.2-2.5); NPS from 6 (IQR, 4.0-7.0) and 5 (IQR, 3.5-6.0), respectively, to 1 (IQR, 0.0-2.0) and 0 (IQR, 0.0-3.0) and SNOT-22 from 64 (IQR, 56-78) and 71 (IQR, 47.5-76.0) respectively, to 5.5 (IQR, 4-21) and 6 (IQR, 4-15). IgE reduced from 57 to 22.1 and from 46.9 to 30.2 in Group A and Group B respectively (p < 0.001). Dupilumab improves symptom severity, polyp size, and health-related quality of life, regardless of the presence or absence of comorbid aeroallergen sensitization and previous administration of biologic therapy.

Introduction: Using machine learning to identify clinical biomarkers for determining optimal response to mepolizumab in chronic rhinosinusitis with nasal polyps. Methods: Single center retrospective observational study with 84 CRSwNP patients treated with mepolizumab. We evaluated 4 machine learning algorithms: Decision Tree, Logistic Regression, K-Nearest Neighbors and Extreme Gradient Boosting. K-Fold cross-validation incorporating hyperparameter optimization in the process was used to ensure robustness and prevent overfitting. Results: After 6, 12 and 24 months, SNOT-22, VAS overall symptom score, VAS-smell, asthma control test (ACT) and nasal polyp score (NPS) significantly improved ( p < 0.001). 44.1% of patients were classified as “super-responders” after 2-year of Mepolizumab treatment based on EPOS/Euforea criteria. XGBoost emerged as the most accurate for predicting super-response to mepolizumab, achieving an ROC- AUC of 0.766. In contrast, Logistic Regression was the least effective for predicting sustained super-response at 24 months, with an ROC-AUC of 0.628. Significant predictors included Blood Neutrophilia and Blood Eosinophilia where higher baseline scores were linked to higher probabilities of super-response at 24 months. Shapley Additive Explanations were employed to identify the most critical baseline features and to visualize their directional impacts on treatment responses. Conclusions: Machine learning models, particularly XGBoost, can predict real-world super-response to mepolizumab in severe CRSwNP by identifying key predictors like high baseline BEC, high baseline BNC and AERD comorbidity. These insights have the potential to refine CRSwNP treatment strategies and support clinical decision-making, ultimately enhancing patient outcomes by predicting treatment response prior to starting medication

Background: Olfactory dysfunction (OD) is a key symptom of chronic rhinosinusitis with nasal polyps (CRSwNP). Dupilumab improves clinical outcomes, including patient-reported olfactory function. This study aimed to analyze correlations between patient-reported olfactory improvement, quality of life, and endoscopic outcomes in patients treated with dupilumab. Methods: A real-life, single-center retrospective study included 35 patients with severe, uncontrolled CRSwNP treated with dupilumab. Patient-reported olfactory function was assessed using a visual analog scale (VAS-olfaction), quality of life with the Sinonasal Outcome Test-22 (SNOT-22), and polyp size with the Nasal Polyp Score (NPS) at baseline, 6 months, and 12 months. Changes from baseline were analyzed using the Wilcoxon signed-rank test, whereas correlations were evaluated using Spearman’s rank correlation coefficient. Results: Dupilumab was associated with significant improvements in patient-reported olfactory function, quality of life, and polyp size at 6 and 12 months. Improvements in VAS-olfaction correlated significantly with SNOT-22 at 6 months (p = 0.035) and 12 months (p = 0.024). In a sensitivity analysis excluding the smell/taste item from the SNOT-22, these correlations were attenuated and no longer reached statistical significance. No significant correlation was observed between patient-reported olfactory improvement and NPS. Conclusions: Patient-reported olfactory improvement correlated with quality of life but not with reductions in global polyp burden. These findings suggest that this improvement may not be fully explained by changes in polyp size alone.