Tezepelumab only biologic to consistently reduce exacerbations in severe allergic asthma

LOUISVILLE, Ky. — Of approved biologics for severe, allergic asthma, tezepelumab was the only one to consistently reduce the annualized exacerbation rate across patient subgroups, according to a literature review.

These results were presented in an oral abstract at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“Patients with uncontrolled, severe allergic asthma may be prescribed biologic therapies to reduce exacerbations and improve disease control,” Jonathan A. Bernstein, MD, FACAAI, professor of clinical medicine in the department of internal medicine, division of immunology/allergy section at the University of Cincinnati, and colleagues wrote. “Randomized controlled trials of these therapies have differed in design, with varying results overall and by baseline blood eosinophil count.”

In a literature review, Bernstein and colleagues identified phase 3 randomized controlled trials on various FDA-approved biologic therapies for patients with a confirmed allergy to perennial aeroallergens, according to the study abstract.

Researchers included studies that evaluated annualized asthma exacerbation rate (AAER) reduction with the biologic vs. placebo in the overall population and/or among patients with either a high or low blood eosinophil count at baseline. They then used these data to compare biologics across different subgroups.

When evaluating the overall population, researchers found that tezepelumab (Tezspire; Amgen, AstraZeneca) showed the greatest AAER reduction compared with dupilumab (Dupixent; Regeneron, Sanofi) and omalizumab (Xolair; Genentech, Novartis). Specifically, researchers observed rate ratios (RR) of 0.42 (95% CI, 0.33-53) with tezepelumab compared with 0.54 (95% CI, 0.4-0.74) for 300 mg dupilumab, 0.63 (95% CI, 0.46-0.87) for 200 mg dupilumab, and 0.75 (95% CI, 0.61-0.92) for omalizumab.

Tezepelumab also conferred an AAER reduction among individuals with perennial allergy and blood eosinophil count less than 300 cells/L (RR = 0.55; 95% CI, 0.4-0.75); this reduction persisted regardless of a blood eosinophil count history and was not found with mepolizumab (Nucala, GlaxoSmithKline), benralizumab (Fasenra, AstraZeneca) or omalizumab, according to the abstract.

For patients with blood eosinophil counts of 300 cells/L or greater, researchers found AAER reductions with all the biologics assessed, but with greater reductions for tezepelumab (RR = 0.31; 95% CI, 0.21-0.44) than with dupilumab (200 mg, RR = 0.43; 300 mg, RR = 0.38; 95% CI not reached for either), benralizumab (RR = 0.54; 95% CI, 0.39-0.74), mepolizumab (RR = 0.42; 95% CI, 0.28-0.61 and RR = 0.34; 95% CI, 0.22-0.51) and omalizumab (RR = 0.68; 95% CI, 0.52-0.89).

“The efficacy of biologics varies considerably overall and by blood eosinophil count,” Bernstein and colleagues wrote. “These differences can inform provider treatment decisions.”