Tezepelumab novel therapeutic approach in uncontrolled severe non-type 2 asthma, case study suggests

The data resulted from a new case report concerning an 80-year-old female with non-type 2 asthma, which had progressively gotten worse and had been diagnosed 11 years prior.

"This is the first case of a patient who did not respond to sequential bronchial thermoplasty, dupilumab, benralizumab, and mepolizumab but presented with good clinical response to tezepelumab. Therefore, tezepelumab may be useful for patients with non-type 2 asthma," the investigators wrote.

Severe asthma affects about 5%–10% of patients with asthma. Tezepelumab is a human IgG2 monoclonal antibody characterized by its inhibition of thymic stromal lymphopoietin (TSLP). Tezepelumab can be effective in patients with poorly controlled moderate to severe asthma regardless of phenotype (type 2 or non-type 2). Yoshiro Kai, Minami-Nara General Medical Center, Yoshino-gun, Japan, and colleagues describe a case of non-type 2 asthma that progressively worsened over the years. Non-type 2 severe asthma developed during tezepelumab treatment after failed treatment with BT, dupilumab, benralizumab, and mepolizumab.

The case is of an 80-year-old woman, labeled as a ‘never-smoker’ and was diagnosed with asthma 11 years ago. The patient was shown not to have comorbid eosinophilic chronic rhinosinusitis and was also sensitive to receiving aspirin.

She experienced repeated exacerbations needing treatment with systemic corticosteroids despite therapy with medications including high-dose inhaled corticosteroids/long-acting beta-agonists plus long-acting muscarinic antagonists. The patient presented with non-eosinophilic asthma.

The patient was initially treated with bronchial thermoplasty, which was only effective for one year. Treatment with bronchial thermoplasty, dupilumab, benralizumab, and mepolizumab was ineffective. The fourth treatment, which included tezepelumab, was initiated.

There was a significant improvement in the patient's quality of life and symptoms.

The research team noted that eosinophils are an essential part of asthma pathogenesis, adding that dupilumab, mepolizumab, and benralizumab are considered to be useful for Th2-severe asthma treatment. However, due to low eosinophil counts and FeNO levels, the team added that ineffective suppression of IL-13 and IL-5 may have occurred in this case.

In conclusion, Tezepelumab treatment might be a novel therapeutic approach in patients with uncontrolled severe non-type 2 asthma despite BT and previous biologic treatments with dupilumab, benralizumab, and mepolizumab.

"Nevertheless, there is a need to perform further studies evaluating the efficacy and safety of tezepelumab against uncontrolled severe non-type 2 asthma," the research team concluded.

Reference:

Kai Y, Suzuki K, Kataoka R, Sato I, Tamaki S, Muro S. Efficacy of tezepelumab against uncontrolled severe non-type 2 asthma refractory to bronchial thermoplasty, benralizumab, dupilumab, and mepolizumab. Respirol Case Rep. 2024 Feb 27;12(3):e01311. doi: 10.1002/rcr2.1311. PMID: 38420113; PMCID: PMC10898956.