56be94bd47923a12faa6ec9933c021de biomedicines-14-01497.pdf 9a01f9183a2ddb1dfba152ca7cd19e761cd2c5f1 biomedicines-14-01497.pdf baec7a5b08f5ebc7ea540f5a6136bd897e8d788fe994199e9846dd5ab5519dbe biomedicines-14-01497.pdf Title: Recovery of Olfactory Function After Mepolizumab Treatment in Patients with Chronic Rhinosinusitis with Nasal Polyps: Influence of the Number of Surgeries Subject: Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease associated with significant olfactory dysfunction. The real-life effect of mepolizumab on smell recovery and the influence of prior surgery and peripheral eosinophilia remain unclear. Objective: Our objective was to evaluate olfactory outcomes after 12 months of mepolizumab in CRSwNP and analyze the impact of previous surgeries and baseline blood eosinophilia. Methods: This was a prospective observational study including 33 consecutive CRSwNP patients treated with mepolizumab. Olfactory function was assessed using subjective measures (VAS: Visual Analogue Scale; SNOT-22: Sino-nasal outcome test, item 21) and psychophysical testing (BOT-8: Barcelona Olfactory Test, detection and identification). Nasal Polyp Score (NPS), peripheral eosinophilia, and quality of life were recorded. Patients were stratified by number of prior sinonasal surgeries. Results: Significant improvement occurred in all subjective and objective olfactory measures at 12 months (BOT-8 detection: 100% vs. 0%; identification: 71% vs. 0%; VAS: 3 vs. 10; SNOT-22 item 21: 1 vs. 5; all p < 0.05). A lower improvement occurred in patients with 3 prior; however, this subgroup was small (p < 0.001). Baseline blood eosinophilia was not associated with olfactory improvement. Larger baseline polyp size correlated inversely with subjective olfactory gain (r = -0.48; p = 0.03). Conclusions: Twelve months of mepolizumab improved olfactory function in CRSwNP, especially in patients with fewer prior surgeries. Olfactory dysfunction responds to multifactorial mechanisms beyond blood eosinophilia, including tissue remodeling, nostril obstruction and possible neuroinflammatory mechanisms involving central olfactory pathways, supporting psychophysical test assessment and reinforcing olfaction as a marker of therapeutic response. Keywords: chronic rhinosinusitis; nasal polyps; mepolizumab; biologic therapies; olfactory disorders; endoscopic sinus surgery Author: Alda Cardesín, Ana Sogo, Aina Sansa, Mariana Campos, Carlota Rovira and Christian Domingo Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Thu Jul 2 08:42:07 2026 CEST ModDate: Thu Jul 2 08:45:57 2026 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 703475 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- CNXSVA+CMSY10 Type 1 Builtin yes yes yes 123 0 EQRSGV+URWPalladioL-Bold Type 1 Custom yes yes yes 124 0 AIKILW+URWPalladioL-Roma Type 1 Custom yes yes yes 125 0 TWZPXY+VnURWPalladioL Type 1 Custom yes yes yes 126 0 VLCMWJ+URWPalladioL-Ital Type 1 Custom yes yes yes 127 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 216 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 233 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-09-05 03:56:50 CEST RepresentationInformation: biomedicines-14-01497.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-09-04 14:23:42 CEST Size: 703475 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 474 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Study Design Item: Title: Study Population Item: Title: Outcome Measures Item: Title: Assessments Item: Title: Sample Size Calculation Item: Title: Statistical Analysis Item: Title: Results Children: Item: Title: Population Characteristics Item: Title: Improvement in Quality of Life and Olfactory Function Item: Title: Evolution of Olfactory Function After Treatment with Mepolizumab (BOT-8 Detection and Identification at 6 and 12 Months) Item: Title: Influence of the Number of Previous Surgeries Item: Title: Relationship with Eosinophils Item: Title: Relationship with Polyp Size Item: Title: Treatment Safety Item: Title: Discussion Item: Title: Conclusions Item: Title: References Info: Title: Recovery of Olfactory Function After Mepolizumab Treatment in Patients with Chronic Rhinosinusitis with Nasal Polyps: Influence of the Number of Surgeries Author: Alda Cardesín, Ana Sogo, Aina Sansa, Mariana Campos, Carlota Rovira and Christian Domingo Subject: Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease associated with significant olfactory dysfunction. The real-life effect of mepolizumab on smell recovery and the influence of prior surgery and peripheral eosinophilia remain unclear. Objective: Our objective was to evaluate olfactory outcomes after 12 months of mepolizumab in CRSwNP and analyze the impact of previous surgeries and baseline blood eosinophilia. Methods: This was a prospective observational study including 33 consecutive CRSwNP patients treated with mepolizumab. Olfactory function was assessed using subjective measures (VAS: Visual Analogue Scale; SNOT-22: Sino-nasal outcome test, item 21) and psychophysical testing (BOT-8: Barcelona Olfactory Test, detection and identification). Nasal Polyp Score (NPS), peripheral eosinophilia, and quality of life were recorded. Patients were stratified by number of prior sinonasal surgeries. Results: Significant improvement occurred in all subjective and objective olfactory measures at 12 months (BOT-8 detection: 100% vs. 0%; identification: 71% vs. 0%; VAS: 3 vs. 10; SNOT-22 item 21: 1 vs. 5; all p < 0.05). A lower improvement occurred in patients with 3 prior; however, this subgroup was small (p < 0.001). Baseline blood eosinophilia was not associated with olfactory improvement. Larger baseline polyp size correlated inversely with subjective olfactory gain (r = -0.48; p = 0.03). Conclusions: Twelve months of mepolizumab improved olfactory function in CRSwNP, especially in patients with fewer prior surgeries. Olfactory dysfunction responds to multifactorial mechanisms beyond blood eosinophilia, including tissue remodeling, nostril obstruction and possible neuroinflammatory mechanisms involving central olfactory pathways, supporting psychophysical test assessment and reinforcing olfaction as a marker of therapeutic response. 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