Patients with severe asthma need fewer steroid bursts with tezepelumab-ekko
Key takeaways:
- The researchers called the reductions in steroid bursts per year with each biologic treatment significant.
- Patients who used tezepelumab-ekko had more asthma-related comorbidities than other patients.
SAN DIEGO — Patients with severe asthma required fewer steroid bursts with tezepelumab-ekko, according to a poster presented at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
These patients also may have asthma that is more difficult to control compared with patients who use other biologics, Ivana Surjancev, MD, second-year fellow, University of Wisconsin School of Medicine, told Healio.
“Asthma is a mechanistically heterogenous disease process. Many of these biologics have come out as a way to try and target those specific pathways,” Surjancev said.
“We still don’t really know which one is the best for which type of phenotype, but we know that tezepelumab-ekko is the first of the biologics that doesn’t require there to be a specific biomarker in order to be prescribed,” she continued.
Tezepelumab-ekko had better outcomes among patients with higher blood eosinophil counts, considered a T2-high profile, in the NAVIGATOR study, Surjancev said
The UW Health cohort included 15 patients (mean age, 58.1 years; 80% female) who used tezepelumab-ekko (Tezspire; Amgen, AstraZeneca), 43 patients (mean age, 55.3; 67.5% female) who used anti-IL5 biologics and 20 patients (mean age, 54.6 years; 45% female) who used dupilumab (Dupixent; Sanofi/Regeneron).
“We’re looking at tezepelumab-ekko, and we’re comparing it to the other biologic classes [anti-IL5/IL5R and dupilumab] to see if there were differences in outcomes, anything that predicts super response,” Surjancev said.
The researchers considered patients who did not require any steroid bursts or maintenance systemic steroids 1 year after initiating their biologic treatment to be super-responders.
Of the 15 patients on tezepelumab-ekko, 10 had previously trialed another biologic class with suboptimal response.
Two patients required two biologics at the same time during use of tezepelumab-ekko, with one on omalizumab for comorbid chronic spontaneous urticaria and one on dupilumab for comorbid chronic rhinosinusitis wth nasal polyposis.
Three patients discontinued biologic treatment because of financial barriers. One patient discontinued treatment and chose an alternative biologic therapy.
Average numbers of comorbidities related to asthma included 4.5 for the tezepelumab-ekko group, 2.9 for the anti-IL5 group and 3.6 for the dupilumab group.
“The only one that had statistically significant differences in demographic baseline comorbidities was chronic rhinosinusitis with and without nasal polyps, which was much more elevated in the dupilumab group compared with the other two groups,” Surjancev said.
Total steroid bursts per year fell from 2.5 ± 2 to 1.1 ± 1.6 (P < .05) for the tezepelumab-ekko group. They also fell from 4.3 ± 3.1 to 1.7 ± 1.8 (P < .001) for the anti-IL5 group and from 3.6 ± 3.3 to 1 ± 2 (P < .01) for the dupilumab group.
“Despite it being a really small cohort, we still had a significant reduction in steroid bursts per year,” Surjancev said.
The use of these biologics to reduce steroid use reduces the potential for side effects as well, she continued.
“We know there are long-term effects with blood pressure, bone health, blood sugar and weight gain with steroids,” Surjancev said. “We have these biologic pathways that don’t have as many side effects.
“Even though we’re still trying to pinpoint exactly which demographic or which biomarkers can predict clinical response, we have nice response across the board for all of the aforementioned biologic classes,” Surjancev said.
Previous real-world analyses through UW Health found significant improvements in all these metrics with anti-IL5/IL5R biologic treatment, and in ACT scores, steroid bursts and spirometry with dupilumab.
Based on a preliminary analysis, the researchers said that the patients with tezepelumab-ekko may have had asthma that was more difficult to control than patients who used other biologics in prior studies, but total steroid bursts needed still fell with its use.
For more information:
Ivana Surjancev, MD, can be reached at ivana.surjancev.residency@gmail.com.
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