From the Guidelines
Tezepelumab is a viable treatment option for patients with severe asthma, including those with allergic bronchopulmonary aspergillosis (ABPA), as it has been shown to reduce exacerbations and improve symptoms. According to the revised ISHAM-ABPA working group clinical practice guidelines 1, biological agents such as tezepelumab (anti-TSLP) have been used in ABPA patients with positive results. The guidelines suggest that these agents can be helpful in stable treatment-dependent ABPA based on case reports and small case series.
Key Points to Consider
- Tezepelumab works by blocking thymic stromal lymphopoietin (TSLP), an epithelial cytokine that plays a key role in triggering airway inflammation in asthma 1.
- The use of biological agents like tezepelumab should be considered for maintenance therapy for underlying asthma, in addition to their potential benefit in ABPA 1.
- While the evidence for tezepelumab in ABPA is based on case reports and small case series, it is a promising option for patients who do not respond adequately to standard treatments.
- Other biological agents, such as omalizumab, mepolizumab, benralizumab, and dupilumab, have also been used in ABPA patients with positive results, but tezepelumab's unique mechanism of action makes it a valuable addition to the treatment arsenal 1.
Treatment Considerations
- Before starting tezepelumab, patients should undergo baseline assessments, including pulmonary function tests, eosinophil counts, and allergy testing.
- Tezepelumab should be considered as add-on therapy for patients with severe asthma who continue to have exacerbations despite high-dose inhaled corticosteroids, long-acting beta-agonists, and other controller medications.
- Patients may experience side effects such as injection site reactions, headache, or pharyngitis, which should be monitored and managed accordingly.
From the FDA Drug Label
TEZSPIRE is a thymic stromal lymphopoietin (TSLP) blocker, human monoclonal antibody (IgG2λ), indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older with severe asthma. Limitations of Use: • Not for relief of acute bronchospasm or status asthmaticus.
Tezepelumab is indicated for the add-on maintenance treatment of severe asthma in patients 12 years and older. The main use of tezepelumab is to prevent severe asthma attacks and improve breathing. However, it is not used to treat sudden breathing problems or acute bronchospasm. 2
From the Research
Tezepelumab and Asthma
- Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin, an epithelial-cell-derived cytokine implicated in the pathogenesis of asthma 3, 4, 5.
- The treatment of severe uncontrolled asthma has improved with the advent of targeted biologic therapies, including tezepelumab, which has demonstrated efficacy across severe asthma phenotypes 3.
- Tezepelumab has been shown to reduce annualized asthma exacerbation rates versus placebo by 63-71% in eosinophilic severe asthma, by 58-68% in allergic severe asthma, and by 31-41% in oral corticosteroid-dependent asthma 3.
Efficacy of Tezepelumab
- In clinical studies, tezepelumab demonstrated higher efficacy in reducing exacerbations requiring hospitalizations or emergency department visits versus placebo 3, 4.
- Tezepelumab improved lung function, asthma control, and health-related quality of life in patients with severe, uncontrolled asthma 4, 6.
- The use of tezepelumab resulted in lower rates of clinically significant asthma exacerbations than placebo, independent of baseline blood eosinophil counts 5.
Safety and Tolerability
- The frequencies and types of adverse events did not differ meaningfully between the tezepelumab and placebo groups 4, 7.
- No serious adverse events were reported during the follow-up period in a multicenter study of tezepelumab in patients with severe asthma 7.
- The rates of mild adverse effects were comparable to those from registration trials 7.