Optimisation of Treatment in Patients with CRSwNP. an RCT of Mepolizumab and Surgical Treatment with FESS and Mepolizumab Versus Only Mepolizumab Over a 6- and 12-month Follow-up
Optimisation of Treatment in Patients with CRSwNP. an RCT of Mepolizumab and Surgical Treatment with FESS and Mepolizumab Versus Only Mepolizumab Over a 6- and 12-month Follow-up
This clinical trial will compare treatment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. The patients will be randomized to treatment with the biologic drug, Mepolizumab, or the biologic drug Mepolizumab combined with Functional Endoscopic Sinus Surgery (FESS).
The aim of this study is to evaluate the effect of combined treatment with biologic treatment and surgery vs. biologic treatment only.
The hypothesis is that surgical removal of polyps and inflamed tissue from the nasal sinuses will increase the effect of the biologic treatment, leading to a lower disease burden after 6 months of treatment, compared with biologic drugs only. Furthermore, combined biologics and surgery will keep a lower disease burden and better general health after 12 months of treatment than biologics alone.
Inclusion criteria:
Patients ≥ 18 years old at the time of signed informed consent (no upper limit)
Patients who are referred to the outpatient clinic for the following reasons:
NPS ≥ 2+2 out of a score of 8 (max)
Severity measured as an SNOT22 score > 35
One FESS in general anaesthesia performed prior to inclusion (no time limitations)
No course of systemic steroids within the last 3 months, whereas a daily low dose is allowed
Possible doctor's diagnosis of asthma
Type 2 inflammation
Exclusion criteria:
Patients who, because of language barriers, are not able to understand written information and, thus, are not able to answer questionnaires
Patients who currently receive biologics for any other disease
Patients who have previously or currently received biologics for CRS or asthma
Patients who are not able to give informed consent (i.e., patients who are permanently incapable)
Patients who meet ≥1 of the following:
Patients needing FESS or systemic steroids (OCS) during the study period will be excluded after an unscheduled visit (last observation carried forward (LOCF))
Patients who are not eligible because of the investigator's judgement
The effect of the treatment will be evaluated with objective procedures and questionnaires related to CRSwNP and asthma after 3, 6 and 12 months.
Inclusion Criteria:
Patients ≥ 18 years old at the time of signed informed consent (no upper limit)
Patients who are referred to the outpatient clinic for the following reasons:
NPS ≥ 2+2 out of a score of 8 (max)
Severity measured as an SNOT22 score > 35
One FESS surgery in general anaesthesia performed prior to inclusion (no time limitations)
No course of systemic steroids within the last 3 months, whereas a daily low dose is allowed
Possible doctor's diagnosis of asthma
Type 2 inflammation
Exclusion Criteria:
Patients who, because of language barriers, are not able to understand written information and, thus, are not able to answer questionnaires
Patients who currently receive biologics for any other disease
Patients who have previously or currently received biologics for CRS or asthma
Patients who are not able to give informed consent (i.e., patients who are permanently incapable)
Patients who meet ≥1 of the following:
Patients needing FESS or systemic steroids (OCS) during the study period will be excluded after an unscheduled visit (last observation carried forward (LOCF))
Patients who are not eligible because of the investigator's judgement