Tezepelumab reduces asthma exacerbations season by season
Click Here to Manage Email Alerts
Key takeaways:
- Reductions included 59% in the spring allergy season and 70% in the ragweed allergy season.
- Exacerbations fell across all seasons for patients with seasonal and perennial allergies alike.
Tezepelumab reduced exacerbations among patients with severe, uncontrolled asthma across all seasons regardless of their specific seasonal and perennial allergies, according to a study published in Annals of Allergy, Asthma & Immunology.
These findings indicate the biologic’s efficacy for a broad population of patients, Ian D. Pavord, MD, professor of respiratory medicine in the Nuffield Department of Medicine at University of Oxford and respiratory theme lead at NIHR Oxford Biomedical Research Centre, and colleagues wrote.
The study included 528 patients assigned tezepelumab (Tezspire; Amgen, AstraZeneca) and 531 assigned placebo, both from the NAVIGATOR study, for 52 weeks.
Overall, 725 patients (68.5%; mean age, 46.2 years; standard deviation [SD], 16.4; 60.3% female) had perennial and/or seasonal aeroallergen sensitivity, including 680 (64.2%) with a perennial aeroallergen sensitivity, 405 (38.2%) with seasonal aeroallergen sensitivity, and 360 (34%) with both sensitivities.
Also, there were 314 patients (mean age,56.8 years; SD, 12.8; 69.7% female), who were not sensitized to any of the assessed aeroallergens, and 42 with unknown perennial or seasonal allergic status.
Annualized annual exacerbation rates (AAERs) varied by season, defined in the northern hemisphere as winter (January to March), spring (April to June), summer (July to September) and fall (October to December), with data shifted 6 months for the southern hemisphere.
Proportions of patients who experienced at least one exacerbation were higher in the placebo vs. the tezepelumab group in the winter (33.4% vs. 18.3%), spring (23.7% vs. 15.7%), summer (26.9% vs. 13.2%) and fall (33.4% vs. 20.6%)
Compared with the placebo group, the tezepelumab group experienced AAER reductions of 63% (95% CI, 52%-72%) in the winter, 46% (95% CI, 26%-61%) in the spring, 62% (95% CI, 48%-73%) in the summer and 54% (95% CI, 41%-64%) in the fall. The tezepelumab group also had similar AAERs across all calendar seasons.
The patients in the tezepelumab group with perennial aeroallergen sensitizations had AAER reductions of 63% (95% CI, 48% to 74%) in the winter, 58% (95% CI, 36% to 72%) in the spring, 62% (95% CI, 43% to 75%) in the summer and 53% (95% CI, 35% to 66%) in the fall compared with the placebo group. Researchers noted this reduction among patients assigned tezepelumab with and without house dust mite sensitization.
Seasonal peaks in AAER were more pronounced for patients with seasonal aeroallergen sensitization, compared with the patients with perennial sensitization, the researchers continued.
AAER reductions for the tezepelumab group vs. the placebo group among patients with seasonal aeroallergen sensitization included 54% (95% CI, 27%-71%) in the winter, 63% (95% CI, 36%-78%) in the spring, 51% (95% CI, 19%-70%) in the summer and 54% (95% CI, 31%-70%) in the fall.
The tezepelumab group also had lower proportions of patients with an exacerbation per day compared with the placebo group among both patients with seasonal aeroallergen sensitization and perennial aeroallergen sensitizations, the researchers found.
Additionally, the researchers examined results specifically from patients in North America, Europe, Japan and South Korea (NEJS cohort; tezepelumab, n = 314; placebo, n = 309).
Researchers noted fewer patients assigned tezepelumab with an exacerbation per day throughout the year for those with any seasonal aeroallergen sensitivities; with sensitivity to spring aeroallergens including grass mix, common silver birch and Japanese cedar; with sensitivity to spring tree pollen; and with sensitivity to ragweed. Also, the placebo group experienced a peak in this proportion during ragweed season, but the tezepelumab group did not.
Reductions in AAER for patients with seasonal sensitivities on tezepelumab included 58% (95% CI, 39%-71%) for the full year, 59% (95% CI, 29%-77%) in the spring allergy season, defined as March 1 to June 15, and 70% (95% CI, 33%-87%) for the ragweed allergy season, defined as Sept. 1 to 30, compared with those with seasonal sensitivities in the placebo group.
Among those with spring aeroallergen sensitivities, tezepelumab conferred a 61% (95% CI, 43%-74%) reduction in AAER across the full year and 62% (95% CI, 33%-78%) reduction in the spring allergy season.
The tezepelumab patients with spring tree pollen sensitivity specifically also experienced a 58% (95% CI, 34%-73%) reduction in AAER over 52 weeks and a 63% (95% CI, 27%-81%) in the spring allergy season compared with the placebo patients.
Compared with the placebo group, the tezepelumab group experienced a 65% (95% CI, 37%-81%) reduction in AAER across the year and a 72% (95% CI, 14%-91%) during ragweed allergy season, among those patients with ragweed sensitivities.
Based on these findings, the researchers concluded that tezepelumab reduced asthma exacerbations across all seasons regardless of sensitivities to perennial and seasonal aeroallergens, indicating its efficacy as an option for patients with severe allergic asthma.
Perspective
Back to Top
These findings are not surprising, as we know that tezepelumab is effective for severe uncontrolled asthma among patients with environmental allergies. The findings also are significant, as no other biologic targeting type 2 asthma has been shown to have an additive effect seasonally.
In my real-life experience, tezepelumab has been very effective in severe uncontrolled asthma, and this study demonstrates a greater need for attention to seasonality of symptoms in these patients.
I believe this study will bring closer scrutiny to control of seasonal asthma flares among patients with severe asthma and will open up the possibility of preventing them with tezepelumab. Instead of looking merely at the total number of asthma exacerbations over the last year, it may make us examine closer the burden of disease during peak seasons as equally important.
I would like to see more such studies looking at seasonal asthma control, as this brings to the limelight seasonal treatment with a biologic medication, vs. perennial treatment, which is the current norm in the United States.
Collapse
Pavord ID, et al. Ann Allergy Asthma Immunol. 2023;doi:10.1016/j.anai.2023.08.015.
Read more about
Click Here to Manage Email Alerts