Tezepelumab Reduces Oral Corticosteroid Dependence in Severe Asthma, Case Report Shows Functional Recovery
A placebo-controlled trial shows tezepelumab significantly reduces oral corticosteroid dependence in severe asthma, with patients achieving nearly three times the odds of reduction versus placebo. A separate case report documents dramatic functional recovery in an elderly patient who switched from mepolizumab to tezepelumab after inadequate response.
A new study published in The Lancet Respiratory Medicine demonstrates that tezepelumab significantly reduces the need for oral corticosteroids in adults with severe, oral corticosteroid-dependent asthma. The placebo-controlled trial found patients receiving tezepelumab had nearly three times the odds of achieving a greater percentage reduction in oral corticosteroid use at 28 weeks compared to those on placebo.
The trial was conducted across 63 sites in 12 countries, enrolling participants aged 18 to 80 with physician-diagnosed asthma who had been receiving medium- or high-dose inhaled corticosteroids for at least 12 months. Participants were randomly assigned to receive either tezepelumab 210 mg or a placebo subcutaneously every four weeks for 28 weeks, with 83 and 39 patients in each group, respectively. The study was terminated early due to recruitment challenges, leaving 25 of the 122 participants (20 percent) without completing the full study period.
The researchers found significantly higher odds of reaching a category of greater percentage oral corticosteroid reduction at week 28 with tezepelumab than placebo (odds ratio, 2.93). Over the 28-week period, 30 percent of participants in the tezepelumab group experienced at least one asthma exacerbation, compared to 59 percent in the placebo group. Adverse events occurred in 57 percent of tezepelumab patients and 72 percent of placebo patients, while serious adverse events were reported in 8 percent and 13 percent of patients, respectively. Three deaths occurred during the study; none were considered causally related to the study treatment.
The study was funded by AstraZeneca and Amgen, which manufacture tezepelumab. Several authors disclosed ties to these biopharmaceutical companies.
In a separate case report, an 86-year-old woman with long-standing severe asthma showed marked clinical and functional response after switching from mepolizumab to tezepelumab. The patient had been diagnosed with asthma in her 40s and was treated with inhaled triple therapy and mepolizumab for 7.6 years. Despite this treatment, she developed an exacerbation while her type 2 biomarkers normalized. After switching to tezepelumab, her symptoms rapidly resolved, and her forced expiratory volume in one second (FEV₁) increased from 0.64 liters (45.7 percent predicted) to 1.45 liters (103 percent predicted) within two months. The concave flow-volume loop also became almost normal.
This case suggests that chronic airflow limitation in severe asthma is not always irreversible and that switching to tezepelumab may induce dramatic functional recovery even after anti-interleukin-5 therapy. Tezepelumab targets thymic stromal lymphopoietin (TSLP), an upstream epithelial cytokine that drives both type 2 and non-type 2 inflammatory pathways.