Mepolizumab treatment is associated with physical activity and cardiorespiratory fitness irrespective of endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps - Randomised Controlled Trial

Q: How were participants assigned to treatment groups?

Fifty-eight adults with severe CRSwNP were randomized 1:1 to receive either sinus surgery with mepolizumab (FESS) or mepolizumab alone (nonFESS).

Q: What outcomes improved after treatment?

Both groups showed significant increases in VO2max and daily step count, and SNOT-22 scores decreased in both groups, with greater quality-of-life improvement in the FESS group.

Sep 30, 2026

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Cardiorespiratory fitness strongly predicts life expectancy and mortality, while chronic rhinosinusitis with nasal polyps (CRSwNP) often reduces habitual physical activity because of nasal obstruction and high disease burden. A randomized controlled trial evaluated whether mepolizumab, with or without functional endoscopic sinus surgery (FESS), is linked to changes in step count and VO2max/kg, alongside disease burden and patient-reported quality of life over six months.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

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Abstract

Background

Objective

Methods

Results

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Introduction

RESEARCH ARTICLE Mepolizumab treatment is associated with physical activity and cardiorespiratory fitness irrespective of endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps: a randomised controlled trial Tidemandsen Jens a, Hostrup Mortenb, Homøe Anne-Sophiea, Moesgaard Lukasb, Aanæs Kaspera,c, Meteran Howramand and Backer Vibekea,c a Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark; bClinical and Experimental Physiology Group, The August Krogh Section for Human and Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; cDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; dDepartment of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark ABSTRACT Background: Cardiorespiratory fitness is a strong predictor of life expectancy and all-cause mortality. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often experience reduced physical activity levels due to nasal obstruction and high disease burden Objective: To evaluate whether mepolizumab, with or without sinus surgery, is associated with changes in habitual physical activity and cardiorespiratory fitness. Methods: In this randomized trial (NCT05598814), 58 adults with severe CRSwNP were randomized (1:1) to receive either sinus surgery with mepolizumab (FESS) or mepolizumab alone (nonFESS) . Inclusion criteria included CRS symptoms, nasal polyp score (NPS) ≥4, SNOT-22 score> 35, signs of type 2 inflammation, and prior functional endoscopic sinus surgery (FESS) . Patients received 100 mg of mepolizumab every four weeks for six months. No exercise was prescribed, though participants were aware activity was being tracked. Physical activity (step count), fitness score (VO2max/kg), and disease burden were assessed at baseline and follow-up. Results: The FESS (n = 29) and nonFESS (n = 29) groups had a mean age of 52 (14) years, with 74% male participants. Both groups demonstrated significant increases in VO2max (FESS: +1.95 ml/min/kg, +6%, p < 0.001; nonFESS: +1.50 ml/min/kg, +5%, p < 0.001) and daily step count (FESS:+1117 steps, p < 0.001; nonFESS: +1087 steps, p = 0.001) . SNOT-22 scores decreased significantly in both groups, with greater improvement in the FESS group (−42 vs. −32 points, p = 0.040) . Conclusion: Mepolizumab was associated with improvement in physical activity, fitness, and quality of life. FESS provided additional quality-of-life benefits but did not further enhance fitness outcomes. ARTICLE HISTORY Received 11 September 2025 Accepted 10 December 2025 KEYWORDS Chronic rhinosinusitis with nasal polyps; biologics treatment; functional endoscopic sinus surgery; physical activity; fitness Introduction Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) is characterised by chronic inflammation of the nasal cavity and paranasal sinuses, resulting in the formation of nasal polyps [ 1]. Patients with CRS have a substantial disease burden and low health-related quality of life (HRQOL). The overall prevalence of CRS in Europe ranges from 5% to 12%, and 25% of the affected individuals have CRSwNP [2]. Up to 60% of patients with CRSwNP have comorbid asthma [3], often with an endotype that includes both Th2 and ILC2 cells (i.e. type 2 inflammation). An association has been demonstrated between severe CRSwNP disease, measured as sinusopacification (Lund-McKay score), and physical inactivity [4]. This is problematic because of the health benefits of physical activity to quality of life (QoL) and all-cause mortality [5,6]. Indeed, cardiorespiratory fitness is among the best predictors of life expectancy [7] and all-cause mortality [8,9] The current standard of care for CRSwNP is a combination of nasal steroid administration, nasal saline irrigation, short courses of systemic corticosteroids, and sinus sur

FAQs

What was the main objective of the trial?

To evaluate whether mepolizumab, with or without sinus surgery, is associated with changes in habitual physical activity and cardiorespiratory fitness in adults with severe CRSwNP.

How were participants assigned to treatment groups?

Fifty-eight adults with severe CRSwNP were randomized 1:1 to receive either sinus surgery with mepolizumab (FESS) or mepolizumab alone (nonFESS).

What outcomes improved after treatment?

Both groups showed significant increases in VO2max and daily step count, and SNOT-22 scores decreased in both groups, with greater quality-of-life improvement in the FESS group.

Sep 30, 2026

Upload by Blitz