Position paper: Recommendations on the use of mepolizumab in chronic rhinosinusitis with nasal polyps (CRSwNP) in the German healthcare system - Recommendations of the Medical Association of German Allergologists (AeDA) and the Working Groups of Clinical Immunology, Allergology and Environmental Medicine and Rhinology and Rhinosurgery of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) Positionspapier: Empfehlungen zur Anwendung von Mepolizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem - Empfehlungen des äarzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC)

Wrede H.; Schlenter W.; Deitmer T.; Strieth S.; Becker S.; Klimek F.; Welkoborsky H.J.; Wollenberg B.; Cuevas M.; Hintschich C.A.; Zuberbier J.; Rudack C.; Bergmann C.; Bachert C.; Guntinas-Lichius O.; Stöver T.; Klimek L.; Förster-Ruhrmann U.; Olze H.; Chaker A.M.; Beule A.G.; Huppertz T.; Hagemann J.; Dazert S.; Hoffmann T.K.

Zusammenfassung

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. Methods A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. Results Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. Conclusions Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.