Peak nasal inspiratory flow assessment of polyp size and response from SYNAPSE
Background: In the phase III SYNAPSE study, mepolizumab plus standard of care reduced total endoscopic nasal polyp score (NPS) versus that with placebo in patients with chronic rhinosinusitis with nasal polyps. Objective: Our aim was to investigate relationships between NPS and (1) peak nasal inspir...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-11-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829324001231 |
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| Summary: | Background: In the phase III SYNAPSE study, mepolizumab plus standard of care reduced total endoscopic nasal polyp score (NPS) versus that with placebo in patients with chronic rhinosinusitis with nasal polyps. Objective: Our aim was to investigate relationships between NPS and (1) peak nasal inspiratory flow (PNIF) and (2) patient-reported outcomes. Methods: In this post hoc analysis, patients randomized 1:1 received mepolizumab, 100 mg, or placebo subcutaneously every 4 weeks (plus standard of care). Changes from baseline in PNIF (week 52), visual analog scale scores (overall symptoms, nasal obstruction, and loss of smell [weeks 49-52]), and total 22-Item Sino-Nasal Outcome Test score (week 52) were assessed in patients with or without improvements in NPS (improvement of ≥1 point) or without (improvement of <1 point or worsening). Results: Patients with improvements in NPS had greater improvements in PNIF (a median of 50 L per minute [interquartile range (IQR) = 10.5-87.5] with mepolizumab vs a median of 40 L per minute [IQR = 0-85.0] with placebo) than did those patients without improvements in NPS (a median of 0.0 L per minute [IQR = –10.0 to 45.0] with mepolizumab vs a median of 0.0 L per minute [IQR = –30.0 to 30.0] with placebo). Similar results were seen for the following: change from baseline in overall symptoms (a median of –5.8 [IQR = –8.1 to –3.80] with mepolizumab and a median of –4.1 [IQR = –7.0 to –1.2] with placebo with improvement in NPS vs a median of –1.3 [IQR = –6.3 to 0.0] with mepolizumab and a median of –0.1 [IQR = –3.4 to 0.0] with placebo without improvement in NPS); change in nasal obstruction (a median of –5.7 [IQR = –8.2 to –3.5] with mepolizumab and a median of –4.5 [IQR = –7.3 to –1.2] with placebo with improvement in NPS vs a median of –1.3 [IQR = –6.6 to 0.0] with mepolizumab and a median of 0.0 [IQR = –3.6 to 0.0] with placebo without improvement in NPS); change in loss of smell (a median of –2.8 [IQR = –7.9 to 0.0] with mepolizumab and a median of –0.7 [IQR = –4.0 to 0.0] with placebo with improvement in NPS vs a median of 0.0 [IQR = –2.4 to 0.0] with mepolizumab and a median of 0.0 [IQR = –0.3 to 0.0]) with placebo without improvement in NPS); and change in visual analog scale score and 22-Item Sino-Nasal Outcome Test total score (a median of –37.0 [IQR = –52.0 to –24.0] with mepolizumab and a median of –29.0 [IQR = –43.0 to –9.0] with placebo with improvement in NPS vs a median of –16.0 [IQR = –42.0 to 0.0] with mepolizumab and a median of 0.0 [IQR = –27.0 to 0.0] with placebo without improvement in NPS). Conclusion: Improvement in NPS was associated with improvements in PNIF and patient-reported outcomes irrespective of treatment. PNIF could be a useful noninvasive tool for monitoring nasal polyp size. |
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| ISSN: | 2772-8293 |