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Nucala for use in adults with chronic rhinosinusitis with nasal polyps, FDA approved


The US Food and Drug Administration ( FDA ) has approved Nucala ( Mepolizumab ), a monoclonal antibody that targets interleukin-5 ( IL-5 ), as a treatment for patients with chronic rhinosinusitis with nasal polyps ( CRSwNP ).
This new indication for Mepolizumab is for the add-on maintenance treatment of CRSwNP in adult patients 18 years of age and older with inadequate response to nasal corticosteroids.

Chronic rhinosinusitis with nasal polyps accounts for 2-4% of the US population, affecting more than 5 million people.
CRSwNP is one of a variety of diseases arising from inflammation in different tissues associated with elevated levels of a type of white blood cell called eosinophils. It is often characterised by raised eosinophil levels, in which soft tissue growth, known as nasal polyps, develop in the sinuses and nasal cavity.
CRSwNP can cause chronic symptoms such as nasal obstruction, loss of smell, facial pressure and nasal discharge.

Mepolizumab is the first anti-IL-5 biologic to be approved for adult patients with chronic rhinosinusitis with nasal polyps in the US.

The approval of Mepolizumab as a treatment for CRSwNP is based on data from the pivotal SYNAPSE study which has explored the effect of Mepolizumab versus placebo in over 400 patients with CRSwNP.
Mepolizumab has achieved significant improvement in reducing the size of nasal polyps and nasal obstruction.
All patients in the study have received standard care, had a history of previous surgery ( approximately one in three had 3 or more surgeries ) and were in need of further surgery due to severe symptoms and increased size of their polyps.
SYNAPSE has shown that there was a 57% reduction in the proportion of patients who had surgery in the group treated with Mepolizumab vs placebo, hazard ratio, HR=0.43 ( 95% CI 0.25, 0.76 ).
In addition, the proportion of patients requiring systemic corticosteroid use during the 52-week treatment period was lower in patients who received Mepolizumab.

Mepolizumab is also approved for use in three other eosinophilic driven diseases, the first indication being for patients with severe eosinophilic asthma aged six years and older.
Additionally, Mepolizumab was the first biologic therapy indicated for adults with eosinophilic granulomatosis with polyangiitis ( EGPA ) and also the first biologic to be approved for patients aged 12 years and older with hypereosinophilic syndrome ( HES ).

Chronic rhinosinusitis with nasal polyps is a chronic inflammatory disease of the nasal passage linings or sinuses which can lead to soft tissue growths known as nasal polyps and is often characterised by elevated levels of eosinophils.
The resultant swellings can grow in both nostrils ( bilateral ) greatly impacting a patient due to various symptoms including nasal obstruction, loss of smell, facial pressure and nasal discharge.
Surgery may be indicated for severe cases. However, polyps have a strong tendency to reoccur often leading to repeat surgery. ( Xagena )

Source: GSK, 2021

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