Dual-Airway Multidimensional Remission with Mepolizumab in Severe Airway Disease: A 156-Week Real-World Study

Background: Severe Type 2 (T2)-high eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) reflect a unified airway inflammatory continuum. Real-world, long-term (3-year) data evaluating dual-airway effectiveness and global clinical remission remain scarce. Methods: This single-center, real-world cohort study evaluated 88 patients with severe uncontrolled T2-high eosinophilic asthma receiving subcutaneous mepoli-zumab (100 mg every 4 weeks) over 156 consecutive weeks. Outcomes were assessed at baseline, 52 weeks, and 156 weeks. Dual-airway benefits were analyzed in a comorbid CRSwNP subgroup (n=51) using SNOT-22, Bilateral Nasal Polyp Score (NPS), and smell loss Visual Analogue Scale (VAS) against 2026 EUFOREA global remission criteria. Results: Mepolizumab induced sustained control over 3 years. Mean ACT scores improved from 13.63±3.94 (baseline) to 21.53±3.01 at 156 weeks (p< 0.0001). Annual exacerbations decreased by 85.5% at Year 3 (0.48±0.61 events/year; p< 0.0001). Daily oral corticosteroid maintenance fell by 81.9% (p=0.027). FEV₁ increased by +241 mL at Year 1 and remained completely stable through Year 3 (2625±797.5 mL). Parallel improvements occurred in SNOT-22, NPS, and VAS scores within the CRSwNP subgroup, meeting global remission benchmarks. Conclusion: Continuous 3-year mepolizumab delivers synchronized dual-airway benefits, preserves long-term lung function, minimizes oral corticosteroid reliance, and achieves high rates of multidimensional global airway remission.