The launch this month of mepoluzimab, an injectable monoclonal antibody, which targets IL-5, a cytokine involved in the inflammatory cascade is responsible for recruiting and activating eosinophils, the white blood cells associated with allergic inflammation. While this drug has been launched mainly for people with hard-to-treat asthma, previous small-scale trials have also shown some benefit in patients with chronic sinusitis with nasal polyposis. Sinus experts believe that this drug may prove of benefit in a small number of patients with severe nasal polyps resistant to all other forms of therapy. Interestingly, this drug appears most effective in patients with high blood levels of eosinophils (a white blood cell containing granules that are readily stained by eosin), and represent the first form of ‘personalized medicine‘ for the respiratory passages.
Mepoluzimab joins another already available monoclocal antibody, omaluzimab (Xolair) , which targets IgE, another important molecule implicated in the inflammatory cascade which characterizes asthma and chronic sinusitis. While omaluzimab is currently marketed for use in asthma and chronic idiopathic urticaria (Hives; an inflammatory skin disorder) results of the small trial published two years ago in the Journal of Allergy and Clinical Immunology suggested that it might also be effective in certain cases of chronic sinusitis and the drug has enjoyed some success in selected patients with severe disease.
Of particular interest however remains that these two drugs will soon be accompanied by several other similar medications targeting various portions of the inflammatory cascade implicated in asthma and chronic sinusitis. It appears that individuals with hard-to-treat chronic sinusitis will have in the future a variety of novel options available for the management of their disease.
An open question remains how the cost of these therapies will be integrated into the healthcare system. While these medications have a high monthly cost, they may represent the only option available to patients refractory to both medication and surgery, and represent a safe alternative to medications such as prednisone, which carry a high risk of side effects which would better be avoided. Careful selection of patients to restrict therapy to those needing it most will hopefully keep overall costs low while allowing those patients who need these important new drugs to benefit.
Prepapred by Paul Keith, Professor, Division of Allergy and Immunology, McMaster University, Hamilton, Ontario
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