Summary

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• Mepolizumab (Nucala) is indicated for add-on maintenance treatment of severe asthma with an eosinophilic phenotype, chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA), and hypereosinophilic syndrome (HES).
• A total of 33 studies from systematic reviews and meta-analyses were reviewed.
• In pediatric CRSwNP, mepolizumab shows potential but requires additional phase III trials to confirm its efficacy compared to other biologics like dupilumab.
• Safety profile analysis indicates that mepolizumab has a comparable adverse event profile to placebo, though it reports unique observations such as upper respiratory tract infections and pulmonary mass issues.
• For type 2 high asthma patients, mepolizumab demonstrates lesser improvement in lung function compared to tezepelumab and dupilumab which show superior outcomes in exacerbations reduction.
• In treating EGPA, both 100 mg and 300 mg doses of mepolizumab are effective. It presents notable relapse rates but remains well-studied through randomized controlled trials compared to benralizumab's preliminary results.
• Real-world studies reinforce the efficacy seen in controlled trials for severe asthma by showing significant reductions in exacerbation rates, mean daily oral corticosteroid dose requirements, improved lung function, and health-related quality of life improvements when using mepolizumab.
• Comparative analyses indicate that while dupilumab often outperforms or matches the effectiveness of mepolizumab across various indications including CRSwNP management; however, further direct head-to-head comparisons are required.