*: events per patient-year-trough week 52; †: least-squares mean change from baseline at week 52; -: not measured. AAER: annualized asthma exacerbation rate; ACQ-6: six-item Asthma Control Questionnaire; AQLQ[S] + 12: Asthma Quality of Life Questionnaire [standardized] for patients 12 years of age or older; ASD: asthma symptom diary; FEV1: forced expiratory volume in the 1st second; PS: parent study
Declarations
Author contributions
AK, GP, AB, NA, EK, ET, and MS: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. NR: Conceptualization, Validation, Writing—review & editing, Supervision. All authors read and approved the submitted version.
Conflicts of interest
Nikoletta Rovina who is the Editorial Board Member and the Guest Editor of Exploration of Asthma & Allergy had no involvement in the decision-making or the review process of this manuscript. The other authors declare that they have no conflicts of interest.
globalasthmareport.org [Internet].The Global Asthma Network; [cited 2024 Mar 15]. Available from: http://globalasthmareport.org/
Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.Eur Respir J. 2014;43:343–73. [DOI] [PubMed]
ginasthma.org [Internet].Global Initiative for Asthma – GINA; c2024 [cited 2024 Mar 15]. Available from: https://ginasthma.org/
McDonald VM, Hiles SA, Jones KA, Clark VL, Yorke J. Health-related quality of life burden in severe asthma.Med J Aust. 2018;209:S28–33. [DOI] [PubMed]
Porsbjerg C, Menzies-Gow A. Co-morbidities in severe asthma: Clinical impact and management.Respirology. 2017;22:651–61. [DOI] [PubMed]
Scelo G, Torres-Duque CA, Maspero J, Tran TN, Murray R, Martin N, et al. Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry.Ann Allergy Asthma Immunol. 2024;132:42–53. [DOI] [PubMed]
Lefebvre P, Duh MS, Lafeuille MH, Gozalo L, Desai U, Robitaille MN, et al. Acute and chronic systemic corticosteroid-related complications in patients with severe asthma.J Allergy Clin Immunol. 2015;136:1488–95. [DOI] [PubMed]
Bleecker ER, Menzies-Gow AN, Price DB, Bourdin A, Sweet S, Martin AL, et al. Systematic Literature Review of Systemic Corticosteroid Use for Asthma Management.Am J Respir Crit Care Med. 2020;201:276–93. [DOI] [PubMed] [PMC]
Sweeney J, Patterson CC, Menzies-Gow A, Niven RM, Mansur AH, Bucknall C, et al.; British Thoracic Society Difficult Asthma Network. Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry.Thorax. 2016;71:339–46. [DOI] [PubMed]
Rice JB, White AG, Scarpati LM, Wan G, Nelson WW. Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review.Clin Ther. 2017;39:2216–29. [DOI] [PubMed]
Volmer T, Effenberger T, Trautner C, Buhl R. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature.Eur Respir J. 2018;52:1800703. [DOI] [PubMed]
Kuruvilla ME, Lee FE, Lee GB. Understanding Asthma Phenotypes, Endotypes, and Mechanisms of Disease.Clin Rev Allergy Immunol. 2019;56:219–33. [DOI] [PubMed] [PMC]
Papaioannou AI, Fouka E, Ntontsi P, Stratakos G, Papiris S. Paucigranulocytic Asthma: Potential Pathogenetic Mechanisms, Clinical Features and Therapeutic Management.J Pers Med. 2022;12:850. [DOI] [PubMed] [PMC]
Carr TF, Zeki AA, Kraft M. Eosinophilic and Noneosinophilic Asthma.Am J Respir Crit Care Med. 2018;197:22–37. [DOI] [PubMed] [PMC]
Lambrecht BN, Hammad H. The immunology of asthma.Nat Immunol. 2015;16:45–56. [DOI] [PubMed]
Habib N, Pasha MA, Tang DD. Current Understanding of Asthma Pathogenesis and Biomarkers.Cells. 2022;11:2764. [DOI] [PubMed] [PMC]
Hong H, Liao S, Chen F, Yang Q, Wang DY. Role of IL-25, IL-33, and TSLP in triggering united airway diseases toward type 2 inflammation.Allergy. 2020;75:2794–804. [DOI] [PubMed]
Roan F, Obata-Ninomiya K, Ziegler SF. Epithelial cell-derived cytokines: more than just signaling the alarm.J Clin Invest. 2019;129:1441–51. [DOI] [PubMed] [PMC]
Hammad H, Lambrecht BN. The basic immunology of asthma.Cell. 2021;184:1469–85. [DOI] [PubMed]
Tanaka J, Watanabe N, Kido M, Saga K, Akamatsu T, Nishio A, et al. Human TSLP and TLR3 ligands promote differentiation of Th17 cells with a central memory phenotype under Th2-polarizing conditions.Clin Exp Allergy. 2009;39:89–100. [DOI] [PubMed] [PMC]
Porsbjerg CM, Sverrild A, Lloyd CM, Menzies-Gow AN, Bel EH. Anti-alarmins in asthma: targeting the airway epithelium with next-generation biologics.Eur Respir J. 2020;56:2000260. [DOI] [PubMed] [PMC]
Dorey-Stein ZL, Shenoy KV. Tezepelumab as an Emerging Therapeutic Option for the Treatment of Severe Asthma: Evidence to Date.Drug Des Devel Ther. 2021;15:331–8. [DOI] [PubMed] [PMC]
Mullard A. Tezepelumab prepares to enter the asthma antibody fray.Nat Rev Drug Discov. 2021;20:91. [DOI] [PubMed]
Jirapongsananuruk O, Leung DY. The modulation of B7.2 and B7.1 on B cells by immunosuppressive agents.Clin Exp Immunol. 1999;118:1–8. [DOI] [PubMed] [PMC]
Busse W, Corren J, Lanier BQ, McAlary M, Fowler-Taylor A, Cioppa GD, et al. Omalizumab, anti-IgE recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma.J Allergy Clin Immunol. 2001;108:184–90. [DOI] [PubMed]
Pavord ID, Korn S, Howarth P, Bleecker ER, Buhl R, Keene ON, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial.Lancet. 2012;380:651–9. [DOI] [PubMed]
Castro M, Zangrilli J, Wechsler ME, Bateman ED, Brusselle GG, Bardin P, et al. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.Lancet Respir Med. 2015;3:355–66. [DOI] [PubMed]
Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, et al.; SIROCCO study investigators. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial.Lancet. 2016;388:2115–27. [DOI] [PubMed]
Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma.N Engl J Med. 2018;378:2486–96. [DOI] [PubMed]
Kyriakopoulos C, Gogali A, Markozannes G, Kostikas K. Biologic agents licensed for severe asthma: a systematic review and meta-analysis of randomised controlled trials.Eur Respir Rev. 2024;33:230238. [DOI] [PubMed] [PMC]
Pitre T, Jassal T, Angjeli A, Jarabana V, Nannapaneni S, Umair A, et al. A comparison of the effectiveness of biologic therapies for asthma: A systematic review and network meta-analysis.Ann Allergy Asthma Immunol. 2023;130:595–606. [DOI] [PubMed]
Charles D, Shanley J, Temple SN, Rattu A, Khaleva E, Roberts G. Real-world efficacy of treatment with benralizumab, dupilumab, mepolizumab and reslizumab for severe asthma: A systematic review and meta-analysis.Clin Exp Allergy. 2022;52:616–27. [DOI] [PubMed] [PMC]
Phinyo P, Krikeerati T, Vichara-Anont I, Thongngarm T. Efficacy and Safety of Biologics for Oral Corticosteroid-Dependent Asthma: A Systematic Review and Network Meta-Analysis.J Allergy Clin Immunol Pract. 2024;12:409–20. [DOI] [PubMed]
Menzies-Gow A, Steenkamp J, Singh S, Erhardt W, Rowell J, Rane P, et al. Tezepelumab compared with other biologics for the treatment of severe asthma: a systematic review and indirect treatment comparison.J Med Econ. 2022;25:679–90. [DOI] [PubMed]
He R, Geha RS. Thymic stromal lymphopoietin.Ann N Y Acad Sci. 2010;1183:13–24. [DOI] [PubMed] [PMC]
Nakajima S, Kabata H, Kabashima K, Asano K. Anti-TSLP antibodies: Targeting a master regulator of type 2 immune responses.Allergol Int. 2020;69:197–203. [DOI] [PubMed]
Duchesne M, Okoye I, Lacy P. Epithelial cell alarmin cytokines: Frontline mediators of the asthma inflammatory response.Front Immunol. 2022;13:975914. [DOI] [PubMed] [PMC]
Gauvreau GM, Sehmi R, Ambrose CS, Griffiths JM. Thymic stromal lymphopoietin: its role and potential as a therapeutic target in asthma.Expert Opin Ther Targets. 2020;24:777–92. [DOI] [PubMed]
Marone G, Spadaro G, Braile M, Poto R, Criscuolo G, Pahima H, et al. Tezepelumab: a novel biological therapy for the treatment of severe uncontrolled asthma.Expert Opin Investig Drugs. 2019;28:931–40. [DOI] [PubMed]
Watanabe N, Hanabuchi S, Soumelis V, Yuan W, Ho S, de Waal Malefyt R, et al. Human thymic stromal lymphopoietin promotes dendritic cell–mediated CD4+ T cell homeostatic expansion.Nat Immunol. 2004;5:426–34. [DOI] [PubMed]
Hanabuchi S, Ito T, Park WR, Watanabe N, Shaw JL, Roman E, et al. Thymic stromal lymphopoietin-activated plasmacytoid dendritic cells induce the generation of FOXP3+ regulatory T cells in human thymus.J Immunol. 2010;184:2999–3007. [DOI] [PubMed] [PMC]
Kitajima M, Lee HC, Nakayama T, Ziegler SF. TSLP enhances the function of helper type 2 cells.Eur J Immunol. 2011;41:1862–71. [DOI] [PubMed] [PMC]
Smolinska S, Antolín-Amérigo D, Popescu FD, Jutel M. Thymic Stromal Lymphopoietin (TSLP), Its Isoforms and the Interplay with the Epithelium in Allergy and Asthma.Int J Mol Sci. 2023;24:12725. [DOI] [PubMed] [PMC]
Wong CK, Hu S, Cheung PF, Lam CW. Thymic stromal lymphopoietin induces chemotactic and prosurvival effects in eosinophils: implications in allergic inflammation.Am J Respir Cell Mol Biol. 2010;43:305–15. [DOI] [PubMed]
Okayama Y, Okumura S, Sagara H, Yuki K, Sasaki T, Watanabe N, et al. FcepsilonRI-mediated thymic stromal lymphopoietin production by interleukin-4-primed human mast cells.Eur Respir J. 2009;34:425–35. [DOI] [PubMed]
Kashyap M, Rochman Y, Spolski R, Samsel L, Leonard WJ. Thymic stromal lymphopoietin is produced by dendritic cells.J Immunol. 2011;187:1207–11. [DOI] [PubMed] [PMC]
Ying S, O’Connor B, Ratoff J, Meng Q, Mallett K, Cousins D, et al. Thymic stromal lymphopoietin expression is increased in asthmatic airways and correlates with expression of Th2-attracting chemokines and disease severity.J Immunol. 2005;174:8183–90. [DOI] [PubMed]
Parnes JR, Molfino NA, Colice G, Martin U, Corren J, Menzies-Gow A. Targeting TSLP in Asthma.J Asthma Allergy. 2022;15:749–65. [DOI] [PubMed] [PMC]
Ying S, O’Connor B, Ratoff J, Meng Q, Fang C, Cousins D, et al. Expression and cellular provenance of thymic stromal lymphopoietin and chemokines in patients with severe asthma and chronic obstructive pulmonary disease.J Immunol. 2008;181:2790–8. [DOI] [PubMed]
Li Y, Wang W, Lv Z, Li Y, Chen Y, Huang K, et al. Elevated Expression of IL-33 and TSLP in the Airways of Human Asthmatics In Vivo: A Potential Biomarker of Severe Refractory Disease.J Immunol. 2018;200:2253–62. [DOI] [PubMed]
Pelaia C, Heffler E, Crimi C, Maglio A, Vatrella A, Pelaia G, et al. Interleukins 4 and 13 in Asthma: Key Pathophysiologic Cytokines and Druggable Molecular Targets.Front Pharmacol. 2022;13:851940. [DOI] [PubMed] [PMC]
Greenfeder S, Umland SP, Cuss FM, Chapman RW, Egan RW. Th2 cytokines and asthma. The role of interleukin-5 in allergic eosinophilic disease.Respir Res. 2001;2:71–9. [DOI] [PubMed] [PMC]
Steinke JW, Borish L. Th2 cytokines and asthma. Interleukin-4: its role in the pathogenesis of asthma, and targeting it for asthma treatment with interleukin-4 receptor antagonists.Respir Res. 2001;2:66–70. [DOI] [PubMed] [PMC]
Rael EL, Lockey RF. Interleukin-13 signaling and its role in asthma.World Allergy Organ J. 2011;4:54–64. [DOI] [PubMed] [PMC]
Romanet-Manent S, Charpin D, Magnan A, Lanteaume A, Vervloet D; EGEA Cooperative Group. Allergic vs nonallergic asthma: what makes the difference?Allergy. 2002;57:607–13. [DOI] [PubMed]
Liu S, Verma M, Michalec L, Liu W, Sripada A, Rollins D, et al. Steroid resistance of airway type 2 innate lymphoid cells from patients with severe asthma: The role of thymic stromal lymphopoietin.J Allergy Clin Immunol. 2018;141:257–68.e6. [DOI] [PubMed] [PMC]
Corren J, Parnes JR, Wang L, Mo M, Roseti SL, Griffiths JM, et al. Tezepelumab in Adults with Uncontrolled Asthma.N Engl J Med. 2017;377:936–46. [DOI] [PubMed]
Corren J, Ambrose CS, Sałapa K, Roseti SL, Griffiths JM, Parnes JR, et al. Efficacy of Tezepelumab in Patients with Severe, Uncontrolled Asthma and Perennial Allergy.J Allergy Clin Immunol Pract. 2021;9:4334–42.e6. [DOI] [PubMed]
Corren J, Karpefors M, Hellqvist Å, Parnes JR, Colice G. Tezepelumab Reduces Exacerbations Across All Seasons in Patients with Severe, Uncontrolled Asthma: A Post Hoc Analysis of the PATHWAY Phase 2b Study.J Asthma Allergy. 2021;14:1–11. [DOI] [PubMed] [PMC]
Menzies-Gow A, Corren J, Bourdin A, Chupp G, Israel E, Wechsler ME, et al. Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma.N Engl J Med. 2021;384:1800–9. [DOI] [PubMed]
Corren J, Menzies-Gow A, Ambrose CS, Colice G, Roseti SL, Hellqvist Å, et al. Effect of tezepelumab on seasonal exacerbations in patients with severe, uncontrolled asthma grouped by blood eosinophil count.Eur Respir J. 2022;60:1641. [DOI]
Corren J, Ambrose CS, Griffiths JM, Hellqvist Å, Lindsley AW, Llanos JP, et al. Efficacy of tezepelumab in patients with evidence of severe allergic asthma: Results from the phase 3 NAVIGATOR study.Clin Exp Allergy. 2023;53:417–28. [DOI] [PubMed]
Menzies-Gow A, Brightling CE, Ambrose CS, Cook B, Hellqvist Å, Llanos Ackert J, et al. Effect of Tezepelumab in Oral Corticosteroid-Dependent Patients with Severe Asthma: Results From the Phase 3 NAVIGATOR Study.Am J Respir Crit Care Med. 2021;203:A1442.
Wechsler ME, Colice G, Griffiths JM, Almqvist G, Skärby T, Piechowiak T, et al. SOURCE: a phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel group trial to evaluate the efficacy and safety of tezepelumab in reducing oral corticosteroid use in adults with oral corticosteroid dependent asthma.Respir Res. 2020;21:264. [DOI] [PubMed] [PMC]
Wechsler ME, Menzies-Gow A, Brightling CE, Kuna P, Korn S, Welte T, et al.; SOURCE study group. Evaluation of the oral corticosteroid-sparing effect of tezepelumab in adults with oral corticosteroid-dependent asthma (SOURCE): a randomised, placebo-controlled, phase 3 study.Lancet Respir Med. 2022;10:650–60. [DOI] [PubMed]
Sverrild A, Hansen S, Hvidtfeldt M, Clausson CM, Cozzolino O, Cerps S, et al. The effect of tezepelumab on airway hyperresponsiveness to mannitol in asthma (UPSTREAM).Eur Respir J. 2022;59:2101296. [DOI] [PubMed]
Emson C, Diver S, Chachi L, Megally A, Small C, Downie J, et al. CASCADE: a phase 2, randomized, double-blind, placebo-controlled, parallel-group trial to evaluate the effect of tezepelumab on airway inflammation in patients with uncontrolled asthma.Respir Res. 2020;21:265. [DOI] [PubMed] [PMC]
Diver S, Khalfaoui L, Emson C, Wenzel SE, Menzies-Gow A, Wechsler ME, et al.; CASCADE study investigators. Effect of tezepelumab on airway inflammatory cells, remodelling, and hyperresponsiveness in patients with moderate-to-severe uncontrolled asthma (CASCADE): a double-blind, randomised, placebo-controlled, phase 2 trial.Lancet Respir Med. 2021;9:1299–312. [DOI] [PubMed]
Sridhar S, Zhao W, Pham TH, Kearley J, White WI, Wu Y, et al. Tezepelumab decreases matrix remodelling and inflammatory pathways in patients with asthma.Eur Respir J. 2019;54:RCT3785. [DOI]
Pham T, Cook B, Parnes JR, Colice G, Griffiths JM. Tezepelumab Reduces Biomarkers of Airway Remodeling, MMP-10 and MMP-3: Exploratory Results from the Phase 3 NAVIGATOR Study.Am J Respir Crit Care Med. 2022;205:A2359.
Corren J, Pham TH, Garcia Gil E, Sałapa K, Ren P, Parnes JR, et al. Baseline type 2 biomarker levels and response to tezepelumab in severe asthma.Allergy. 2022;77:1786–96. [DOI] [PubMed] [PMC]
Pham TH, Chen C, Colice G, Parnes JR, Griffiths JM, Cook B. Tezepelumab normalizes serum interleukin-5 and -13 levels in patients with severe, uncontrolled asthma.Ann Allergy Asthma Immunol. 2021;127:689–91. [DOI] [PubMed]
Emson C, Corren J, Sałapa K, Hellqvist Å, Parnes JR, Colice G. Efficacy of Tezepelumab in Patients with Severe, Uncontrolled Asthma with and without Nasal Polyposis: A Post Hoc Analysis of the Phase 2b PATHWAY Study.J Asthma Allergy. 2021;14:91–9. [DOI] [PubMed] [PMC]
Corren J, Spahn J, Ambrose C, Martin N, Colice G, Molfino N, et al. EFFECT OF TEZEPELUMAB ON ASTHMA INFLAMMATORY BIOMARKER LEVELS VARIES BY BASELINE BIOMARKER LEVELS.Ann Allergy Asthma Immunol. 2022;129:S36. [DOI]
Menzies-Gow A, Ponnarambil S, Downie J, Bowen K, Hellqvist Å, Colice G. DESTINATION: a phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group trial to evaluate the long-term safety and tolerability of tezepelumab in adults and adolescents with severe, uncontrolled asthma.Respir Res. 2020;21:279. [DOI] [PubMed] [PMC]
Shinkai M, Ebisawa M, Fukushima Y, Takeuchi S, Okada H, Tokiyo T, et al. One-year safety and tolerability of tezepelumab in Japanese patients with severe uncontrolled asthma: results of the NOZOMI study.J Asthma. 2023;60:616–24. [DOI] [PubMed]
Corren J, Menzies-Gow A, Chupp G, Israel E, Korn S, Cook B, et al. Efficacy of Tezepelumab in Severe, Uncontrolled Asthma: Pooled Analysis of the PATHWAY and NAVIGATOR Clinical Trials.Am J Respir Crit Care Med. 2023;208:13–24. [DOI] [PubMed] [PMC]
Menzies-Gow A, Wechsler ME, Brightling CE, Korn S, Corren J, Israel E, et al.; DESTINATION study investigators. Long-term safety and efficacy of tezepelumab in people with severe, uncontrolled asthma (DESTINATION): a randomised, placebo-controlled extension study.Lancet Respir Med. 2023;11:425–38. [DOI] [PubMed]