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Case Reports
. 2024 Jul 11;25(1):272.
doi: 10.1186/s12931-024-02888-x.

Tezepelumab for refractory eosinophilic granulomatosis with polyangiitis-related asthma

Nina Vincent-Galtié  1 , Quentin Marquant  2   3 , Emilie Catherinot  4 , Felix Ackermann  5 , Antoine Magnan  4   2   3 , Colas Tcherakian #  4   3 , Matthieu Groh #  5
Affiliations
Case Reports

Tezepelumab for refractory eosinophilic granulomatosis with polyangiitis-related asthma

Nina Vincent-Galtié et al. Respir Res. .

Abstract

Conventional immunosuppressants are ineffective for the management of EGPA-related asthma. Tezepelumab is a human monoclonal antibody that inhibits thymic stromal lymphopoietin (TLSP) that has proven efficacy in several phase 3 studies for the treatment of asthma. We treated with off-label tezepelumab the first two patients with severe refractory EPGA-related asthma. These preliminary findings suggest that targeting upstream signaling of the T2 inflammatory pathway can improve symptoms, reduce BVAS and increase Asthma Control Test scores, even in patients with refractory asthma who have failed several previous lines of treatment. Nevertheless, by analogy with dupilumab-induced IL-4/13 blockade, the persistence of sputum eosinophilia (reported in both patients) raises questions as to whether TSLP inhibition could lead to a rebound of eosinophilia and potentially to eosinophil-related symptoms in patients with EGPA.

Keywords: Asthma; Eosinophilic granulomatosis with polyangiitis; TSLP; Tezepelumab; Vasculitis.

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Conflict of interest statement

MG and CT: consulting fees from AstraZeneca. EC: consulting fees from AstraZeneca and Sanofi.

Figures

Fig. 1
Fig. 1
Changes in Forced Expiratory Volume 1 (A), Asthma Control Test (B), Birmingham Vasculitis Activity scores (C) and absolute eosinophil counts (D) under treatment with tezepelumab (solid line) or benralizumab (dotted line)
Fig. 2
Fig. 2
May-Grünwald Giemsa staining from induced sputum of patients #1 (A) and #2 (B) under treatment with tezepelumab showing mild and marked sputum eosinophilia (arrows), respectively (X80)
See this image and copyright information in PMC

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