D3.120 - Delivering Severe Asthma Care in the Real World: Insights into Anti-TSLP (Tezepelumab) Use from a Tertiary Allergy and Respiratory Centre

Tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) therapy, targets upstream epithelial inflammation and may benefit allergic, eosinophilic, and non-eosinophilic asthma. However, real-world data, particularly in patients with comorbid chronic rhinosinusitis (CRS) and chronic rhinosinusitis with nasal polyposis (CRSwNP) remain limited.

We retrospectively evaluated adults with severe asthma initiated on anti-TSLP therapy between 2022 and 2024 at a tertiary allergy and respiratory centre. Patients were classified by inflammatory phenotype (allergic, allergic/eosinophilic, eosinophilic, or non-eosinophilic) and by upper airway disease status (CRSwNP, CRS without nasal polyposis, or no CRS). Outcomes assessed at 6–12 months included Annualised Asthma Exacerbation Rate (AAER), Asthma Control Questionnaire-6 (ACQ-6), pre-bronchodilator FEV₁, and maintenance oral corticosteroid (mOCS) use.

A total of 168 adults with severe asthma were included (mean age 52.6 ± 14.4 years), of whom 116 (69%) were female. Atopy was documented in 132 patients (79%), and 103 (61%) had comorbid CRS, including 36 (21%) with CRSwNP. Patients with CRSwNP demonstrated higher baseline blood eosinophil counts compared with those with CRS without nasal polyposis (CRSsNP) and those without CRS. Atopy was markedly more prevalent in patients with CRS, irrespective of nasal polyposis status. Baseline asthma control, assessed using ACQ-6, was similar across these three subgroups. Seventy-two patients were biologic-naïve and initiated Tezepelumab as their first-line biologic therapy. There was no difference in baseline asthma control between biologic-naïve and biologic-experienced patients, as assessed by ACQ-6 (3.10 ± 1.25 vs 3.10 ± 1.29), with both groups demonstrating poorly controlled asthma.  Across all inflammatory phenotypes, including non-eosinophilic asthma, treatment with anti-TSLP therapy was associated with clinically meaningful improvements in asthma outcomes. Treatment responses were comparable regardless of CRS or nasal polyposis status.

Anti-TSLP therapy demonstrates consistent real-world effectiveness across asthma phenotypes and upper airway disease subgroups, including patients with CRS and CRSwNP, supporting its phenotype-agnostic role in the management of severe asthma.