Tezepelumab (CRSwNP / Severe Asthma)

How it works

It is a human monoclonal antibody that binds thymic stromal lymphopoietin (TSLP), an epithelial cytokine upstream of multiple inflammatory pathways, thereby blocking a key initiator of airway and sinonasal type-2 and non-type-2 inflammation.

Prescribing in practice

• It is a biologic for specialist initiation only and must not be used to treat acute asthma exacerbations, acute bronchospasm or status asthmaticus.
• Hypersensitivity reactions can occur, so administer with appropriate observation and counsel patients on recognising delayed reactions.
• Live vaccines should generally be avoided during treatment, and any co-existing helminth infection should be addressed before starting.

Monitoring

Monitor asthma control, exacerbation frequency, polyp/sinonasal symptom scores and for hypersensitivity, reassessing benefit periodically against agreed response criteria.

Counselling the patient

• This is an add-on treatment; keep taking your regular inhalers and other prescribed medicines.
• Do not use it for sudden breathing difficulty or an asthma attack.
• Report any rash, swelling or breathing difficulty after an injection.

Evidence & guidelines

Tezepelumab reduces exacerbations in severe asthma across phenotypes and is supported in UK practice through specialist severe-asthma and emerging CRSwNP pathways.