Case Report: Tezepelumab as rescue therapy in near-fatal asthma requiring extracorporeal membrane oxygenation

Tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) monoclonal antibody, reduces exacerbations across asthma phenotypes, but its role in status asthmaticus and near-fatal exacerbations requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) is unclear.

We report three patients (17, 22, 57 years) with therapy-refractory hypercapnic respiratory failure initiated on VV-ECMO who received tezepelumab 210 mg within 24 h. Tidal volume and minute ventilation increased within 24-72 h, permitting decannulation by days 12-15 and ventilator weaning by days 17-28. Two patients had elevated IgE; one had normal blood eosinophils/IgE. No immediate drug-related adverse events occurred. Follow-up demonstrated lung-function recovery; one patient required escalation of maintenance therapy for persistent symptoms.

In this small series, adjunctive tezepelumab during VV-ECMO-supported status asthmaticus appeared safe and potentially beneficial adjunctive therapy during near-fatal asthma requiring VV-ECMO. Randomized controlled studies are needed to determine the impact of TSLP inhibition on recovery time, ventilation duration, and mortality in this setting.