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Anti-TSLP (thymic stromal lymphopoietin) monoclonal antibody — broad-phenotype biologic Pregnancy: Avoid — insufficient human data; animal studies do not indicate direct harm but immunological effects uncertain.

Tezepelumab

Brand names: Tezspire (210 mg/1.91 mL prefilled syringe)

Adult dose

Dose: 210 mg SC every 4 weeks
Route: Subcutaneous injection (upper arm, thigh, or abdomen)
Frequency: Every 4 weeks
Max: 210 mg every 4 weeks
Severe uncontrolled asthma in adults ≥18 years as add-on maintenance therapy. Unique target: TSLP is an upstream epithelial cytokine that drives both type 2 (eosinophilic, allergic) and non-type 2 asthma inflammation — broader efficacy than IL-5 or IgE biologics. NAVIGATOR trial. NICE TA878 / NICE TA954. Can be used regardless of blood eosinophil count, FeNO, or allergy status — true broad-phenotype biologic.

Paediatric dose

Route: SC
Frequency: Every 4 weeks
Max: 210 mg per dose
Concentration: 110 mg/mL mg/ml
Licensed ≥12 years in the UK (EMA/MHRA approval extended to adolescents). Same dose as adults: 210 mg SC every 4 weeks.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

  • NAVIGATOR trial (Menzies-Gow et al, NEJM 2021): tezepelumab reduces annualised severe exacerbation rate by 70% vs placebo — across all eosinophil count subgroups (including <300 cells/mcL)
  • Broad-phenotype advantage: unlike mepolizumab/benralizumab (require eosinophils ≥150–300) or omalizumab (require elevated IgE), tezepelumab works in both eosinophilic and non-eosinophilic/non-allergic severe asthma
  • Mechanism: TSLP is released by airway epithelium in response to allergens, viruses, pollutants — blockade prevents initiation of both type 2 and non-type 2 cascade
  • NICE TA954 (2024): tezepelumab recommended for severe uncontrolled asthma in adults and adolescents ≥12 years, regardless of blood eosinophil count
  • OCS-sparing potential: SOURCE trial — significantly reduces oral corticosteroid dose in OCS-dependent severe asthma

Contraindications

  • Active helminth infection (treat before starting)
  • Hypersensitivity to tezepelumab

Side effects

  • Injection site reactions
  • Pharyngitis
  • Arthralgia
  • Back pain
  • Hypersensitivity reactions (rare)

Interactions

  • Live attenuated vaccines — avoid during treatment
  • Minimal systemic drug interactions — monoclonal antibody

Monitoring

  • Exacerbation frequency — assess response at 12–16 weeks
  • FEV₁/peak flow
  • OCS dose (steroid-sparing opportunity)
  • Blood eosinophil count (baseline only — not required for eligibility unlike IL-5 biologics)
  • Parasitic infection risk

Reference: BNFc; BNF; NICE TA954 (2024); NAVIGATOR Trial (Menzies-Gow et al, NEJM 2021); SOURCE Trial; GINA 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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