Anti-TSLP (Thymic Stromal Lymphopoietin) Monoclonal Antibody Pregnancy: Use with caution — IgG1 antibody crosses placenta; limited pregnancy data; discuss benefit-risk with patient

Tezepelumab (CRSwNP / Severe Asthma)

Brand names: Tezspire

Adult dose

Dose: 210 mg SC every 4 weeks

Route: Subcutaneous injection

Frequency: Every 4 weeks

Max: 210 mg per dose

Severe uncontrolled asthma (NICE TA879); emerging use in CRSwNP (trials ongoing); broadest biologic mechanism — acts upstream of type 2 and non-type 2 inflammation; no biomarker requirement for asthma indication

Paediatric dose

Dose: Not established N/A/kg

Route: N/A

Frequency: N/A

Max: N/A

Not licensed in paediatrics

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

Not licensed in paediatrics

Clinical pearls

NAVIGATOR trial (Menzies-Gow et al. NEJM 2021): tezepelumab reduced annualised asthma exacerbation rate by 70% vs placebo in severe uncontrolled asthma — uniquely, benefit was consistent regardless of eosinophil count, IgE level, or FeNO (effective in non-eosinophilic/non-type-2 asthma)
TSLP (thymic stromal lymphopoietin) is an epithelial alarmin released in response to environmental triggers (allergens, pollutants, viruses) — acts upstream of the entire inflammatory cascade, inhibiting both type 2 (IL-4/5/13/IgE pathway) and non-type 2 pathways; explains biomarker-agnostic efficacy
MHRA 2022 approved; NICE TA879 for severe uncontrolled asthma without biomarker restriction — fills gap left by other biologics that require eosinophil/IgE/FeNO thresholds; suitable for patients who do not qualify for mepolizumab/benralizumab/omalizumab
CRSwNP relevance: TSLP is highly expressed in sinonasal epithelium and nasal polyp tissue — WAYPOINT trial (tezepelumab for CRSwNP) is ongoing; ENT specialists increasingly familiar with tezepelumab in overlap asthma-CRSwNP patients co-managed with respiratory physicians
No routine blood monitoring required: unlike JAK inhibitors, no FBC/LFT testing needed; reassess asthma control and exacerbation frequency every 12 months per NICE TA879 criteria

Contraindications

Active parasitic (helminth) infections — treat before initiating
Known hypersensitivity to tezepelumab

Side effects

Nasopharyngitis
Headache
Injection site reactions
Arthralgia
Back pain

Interactions

Live vaccines — avoid during treatment

Monitoring

Asthma control (ACQ/ACT scores)
Exacerbation frequency
Oral steroid requirement (steroid-sparing)
Injection site reactions
Nasal symptom scores in CRSwNP overlap

Reference: BNFc; BNF 90; NAVIGATOR trial (Menzies-Gow et al. NEJM 2021); NICE TA879; MHRA SPC Tezspire 2022; WAYPOINT trial (CRSwNP, ongoing); ESMO/ERS Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways