Switching to tezepelumab from other biologics in patients with severe asthma: a retrospective study

Tezepelumab, an anti-thymic stromal lymphopoietin antibody, has shown efficacy in reducing exacerbations and improving control in patients with severe asthma (SA), including those with low type 2 (T2) inflammation. We aimed to evaluate the efficacy and safety of switching to tezepelumab in patients with SA that was inadequately controlled by previous biologics.

In this retrospective study, we included patients with SA previously treated with at least one biologic and subsequently switched to tezepelumab (210 mg every 4 weeks) for ≥24 weeks between December 2022 and December 2023. Clinical outcomes were evaluated using changes in Asthma Control Test (ACT) scores, oral corticosteroid (OCS) dose, pulmonary function, exacerbation frequency, and Biologics Asthma Response Score (BARS). Positive T2 biomarkers were defined as peripheral blood eosinophil count ≥150/μL, immunoglobulin (Ig) E > 167 IU/mL, or exhaled nitric oxide >25 ppb.

Among 22 patients, 77 % were exacerbation-free after 12 weeks, and 64 % were classified as responders (ACT score increase ≥3). Remission (ACT ≥23, no exacerbations, steroid-free) was achieved in 18 %. ACT scores, forced expiratory volume in 1 s (FEV1; median +40 mL, p = 0.0413), and OCS doses significantly improved. According to BARS, 41 and 41 % had "Good response" and "Response," respectively. Improvements were observed in patients switching from anti-IL-5 agents and dupilumab; however, benefits varied by prior biologic.

Tezepelumab may be effective for patients with SA who could not respond to other biologics. Further studies are warranted to evaluate long-term outcomes and optimal patient selection.