If a patient on Tezspire (tezepelumab) misses a dose by 5 days, should they take it now and shift future doses out 5 days or take it now and continue with the original schedule?

Managing a Missed Dose of Tezspire (Tezepelumab)

For a patient who missed their Tezspire dose by 5 days, the patient should take the dose now and continue with the original dosing schedule (every 4 weeks from the original scheduled date).

Rationale for Recommendation

• There are no specific evidence-based guidelines on dose adjustments for missed Tezspire doses, similar to the lack of evidence-based guidelines for allergen immunotherapy 1
• The pharmacokinetic profile of tezepelumab shows it is a monoclonal antibody with properties similar to other immunoglobulin G2 antibodies, with a relatively long half-life 2
• The recommended dosing of Tezspire is 210 mg administered subcutaneously every 4 weeks 3, 4

Clinical Considerations

• Maintaining consistent blood levels of tezepelumab is important for continued efficacy in controlling severe asthma 4, 2
• Real-world data shows tezepelumab can reduce exacerbation rates from 3.1 to 0.8 per year, with 59% of patients remaining exacerbation-free at 1 year 5
• Shifting the entire schedule by 5 days would create unnecessary complexity in the medication regimen and potentially lead to further adherence issues 1

Management Algorithm for Missed Tezspire Dose

1. For doses missed by less than 7 days:

   • Administer the missed dose as soon as possible 1
   • Continue with the original dosing schedule (maintain the same future dates) 1
   • No dose adjustment is necessary 2

2. For doses missed by more than 7 days:

   • Consult with the prescribing physician before administration
   • Consider the patient's current asthma control and risk factors 5

Comparison to Other Medication Classes

• This approach is similar to recommendations for other injectable biologics and consistent with principles applied to:
  • Non-vitamin K antagonist oral anticoagulants (NOACs) with once-daily dosing, where the recommendation is to take the missed dose and continue the regular schedule 1
  • Contraceptives, where taking the missed dose and continuing the regular schedule is recommended for missed doses <48 hours 1

Practical Patient Education Points

• Encourage the patient to set reminders for future doses to improve adherence 1
• Reassure the patient that a 5-day delay is unlikely to significantly impact the overall effectiveness of treatment 2
• Emphasize the importance of maintaining the regular 4-week dosing schedule for optimal asthma control 4, 6
• Remind the patient to monitor for any changes in asthma symptoms and to use rescue medications as needed 5

Monitoring After Missed Dose

• Monitor for any increase in asthma symptoms in the days following the delayed dose 5
• No additional laboratory monitoring is required specifically due to the delayed dose 2
• Continue regular follow-up as previously scheduled 6