Switching from Tezepelumab to Benralizumab in Severe Asthma
Yes, Fasenra (benralizumab) can be initiated 2 weeks after the last Tezspire (tezepelumab) injection, as there are no specific contraindications or waiting periods established between these biologics. While there are no direct studies examining the specific transition between these two medications, we can make this recommendation based on their mechanisms of action and available guidelines.
Rationale for Timing Between Biologics
Benralizumab and tezepelumab work through different mechanisms:
- Benralizumab: An anti-IL-5 receptor α monoclonal antibody that depletes eosinophils 1
- Tezepelumab: A thymic stromal lymphopoietin (TSLP) inhibitor 2, 3
The 2024 European Respiratory Journal guidelines for allergic bronchopulmonary aspergillosis/mycoses provide dosing information for both biologics but do not specify a required washout period between them 1.
Considerations for Biologic Switching
When transitioning between biologics, several factors should be considered:
Pharmacokinetics: Tezepelumab is administered every 4 weeks 2, while benralizumab is initially given every 4 weeks for the first three doses, then every 8 weeks thereafter 1, 4
Immunogenicity: Both medications can induce anti-drug antibodies to some extent 5, but there's no evidence suggesting increased immunogenicity risk when switching between them
Safety profile: Long-term benralizumab treatment has been shown to be safe and well-tolerated for up to 5 years with no new safety signals 6
Clinical Approach to Switching
When switching from tezepelumab to benralizumab:
Timing: Initiate benralizumab 2 weeks after the last tezepelumab dose
- This allows some clearance of the previous biologic while not leaving the patient without treatment for too long
Monitoring: After initiating benralizumab:
- Watch for injection site reactions (common with both biologics)
- Monitor for any signs of hypersensitivity
- Assess clinical response to the new therapy
Follow-up: Schedule a follow-up visit 4-8 weeks after initiating benralizumab to assess efficacy and tolerability
Potential Concerns
- Overlapping immunosuppression: While theoretical, the risk appears minimal as these biologics target different pathways
- Injection site reactions: Both medications can cause these, but they typically diminish in severity over time 1, 4
- Immunogenicity: Monitor for any unusual reactions that might suggest development of anti-drug antibodies 5
Conclusion
Based on the available evidence and clinical practice guidelines, initiating benralizumab 2 weeks after the last tezepelumab injection is a reasonable approach that balances the need for continued asthma control while allowing some clearance of the previous biologic. No specific contraindications exist for this transition timing, and the different mechanisms of action make significant adverse interactions unlikely.