Tezepelumab reduces ED visits, hospitalizations in severe, uncontrolled asthma

Key takeaways:

• Reductions included fewer unscheduled specialist visits, phone calls, ambulance transports and home visits.
• Patients on tezepelumab did not spend any days in the ICU, whereas those on placebo spent 31 days.

Tezepelumab reduced health care utilization for asthma across all outcomes measured, as well as the severity of exacerbations that required hospitalizations, according to a study published in Annals of Allergy, Asthma & Immunology.

These improvements reduce the overall disease burden of asthma, Andrew Menzies-Gow, MD, BSc, MBBS, PhD, FRCP, director of the lung division, Royal Brompton and Harefield Hospitals, School of Immunology & Microbial Sciences, King’s College London, and colleagues wrote.

The NAVIGATOR phase 3 study of patients with severe, uncontrolled asthma included 528 patients who received 210 mg of tezepelumab (Tezspire; Amgen, AstraZeneca) and 531 who received placebo every 4 weeks for 52 weeks.

At baseline, an asthma exacerbation in the previous 12 months caused 15% of the tezepelumab group and 14% of the placebo group to be hospitalized, as well as 9% of each group to visit the ED without hospitalization.

At 52 weeks, the tezepelumab group had fewer asthma-related unscheduled specialist visits, telephone calls with a health care provider, ambulance transports, home visits from a health care provider, ED visits and hospitalizations related to and not related to asthma compared with the placebo group.

The tezepelumab group also had fewer asthma-related days in the hospital than the placebo group, spending 0 days in the ICU compared with the placebo group’s 3-day total.

Additionally, the tezepelumab group had a smaller proportion of patients with one or more exacerbations requiring an ED visit or hospitalization as well as a smaller number of patients who were re-hospitalized compared with the placebo group.

Further, compared with placebo, the annualized rates of all-cause ED visits fell by 28% (95% CI, 2%-46%) and all-cause hospitalizations fell by 59% (95% CI, 35%-74%) with tezepelumab.

The time to first asthma exacerbation requiring an ED visit was longer with tezepelumab compared with placebo as well, with a 65% risk reduction (HR = 0.35; 95% CI, 0.22-0.56), in addition to longer time to first exacerbation requiring hospitalization regardless of ED visit.

Annualized rates of exacerbations requiring an ER visit without hospitalization also fell by 61% (95% CI, 23%-80%) with tezepelumab compared with placebo. Among patients who were hospitalized, 38% of those in the tezepelumab group and 82% of those in the placebo group had exacerbations categorized as severe.

The patients in the tezepelumab group also less frequently reported health care utilization associated with the exacerbation and occurring before hospitalization than the patients in the placebo group.

Additionally, among the patients who were hospitalized, none of those on tezepelumab had a prior ED visit or hospitalization before admission during the 52-week study period, whereas 13% of those on placebo had a prior ED visit and 8% of them had a prior hospitalization.

The symptoms and signs that patients in both groups reported during hospitalizations related to exacerbation were similar, the researchers said, except for fever (8% for the tezepelumab group and 33% of the placebo group), dyspnea (39% of the tezepelumab group and 54% of the placebo group) and tachycardia (8% of the tezepelumab group and 23% of the placebo group).

Based on these findings, the researchers concluded that tezepelumab substantially reduced health care utilization related to asthma in addition to the incidence and severity of exacerbations requiring ED visits, hospitalizations or ICU days, as well as the burdens of severe, uncontrolled asthma for patients and health care systems alike.