Increased Exacerbation Reduction Over Time with Tezepelumab in Severe Asthma: CROSSROADS-4

Tezepelumab is a monoclonal antibody approved in the United States for severe asthma. Real-world evidence of effectiveness remains limited.

To evaluate the effectiveness of tezepelumab in reducing annualized asthma exacerbation rates (AAERs) and healthcare resource utilization (HRU) in the United States.

This retrospective, self-controlled, pre-post cohort study used data from Symphony Health, an ICON plc Company, PatientSource®, December 1, 2020, to June 30, 2024. Eligible patients were ≥12 years, had ≥2 records of tezepelumab, and experienced ≥2 asthma exacerbations in the 12 months before tezepelumab initiation, with index date being the day after initiation. AAERs and asthma exacerbation-related HRU were compared between the 12 months pre- and post-index. AAERs were also evaluated across patient subgroups.

A total of 527 patients were included. AAERs decreased significantly from 2.81 to 1.26 per person-year (55% decrease; 95% confidence interval [CI] [51%, 59%]; p<0.001). The greatest benefit was observed among patients starting treatment February 2023 and later (61% decrease; [53%-67%]; p<0.001). Consistent reductions were seen across subgroups: patients with pre-index blood eosinophil count <300 cells/μL and ≥300 cells/μL, pre-index total serum immunoglobulin E levels <100 IU/mL and ≥100 IU/mL, biologic-naïve and biologic-experienced, persistent tezepelumab users, and those with comorbid chronic obstructive pulmonary disease or chronic rhinosinusitis with nasal polyposis. Asthma exacerbation-related HRU declined significantly (p<0.001) with 50-54% reductions across healthcare settings.

In this real-world study, patients with severe asthma treated with tezepelumab had substantial reductions in asthma exacerbations and HRU, with the greatest benefits among more recent initiators.