Kai Yoshiro
Department of Respiratory Medicine, Minami-Nara General Medical Center, Nara, Japan.
Department of Respiratory Medicine, Nara Medical University, Nara, Japan.
J Allergy Clin Immunol Glob. 2024 Dec 25;4(2):100396. doi: 10.1016/j.jacig.2024.100396. eCollection 2025 May.
Tezepelumab is a human IgG2 mAb that inhibits thymic stromal lymphopoietin (TSLP) and is approved for treatment of severe asthma. Bronchial asthma, usually a type 2 inflammatory disease, often co-occurs with chronic rhinosinusitis with nasal polyps (CRSwNP). However, tezepelumab has unknown effects on severe asthma with CRSwNP. Patients with CRSwNP are frequently candidates for endoscopic sinus surgery (ESS). CRSwNP is a crucial factor influencing asthma symptoms. However, some patients experience recurrent CRSwNP.
Tezepelumab was approved for use with CRSwNP, and TSLP is involved in the pathogenesis of CRSwNP. This study presents the cases of 2 patients with severe asthma complicated with recurrent CRSwNP after ESS in whom tezepelumab rapidly improved asthma and sinusitis symptoms.
We evaluated tezepelumab treatment in patients with severe asthma with recurrent CRSwNP based on symptoms, asthma exacerbation, level of type 2 cytokines, and lung function.
After they had received a high-dose inhaled corticosteroid and long-acting β-agonist, the patients' asthma remained uncontrolled, as defined by a low Asthma Control Test score. However, tezepelumab reduced severe asthma exacerbation, improved lung function, and controlled asthma symptoms. It improved CRSwNP, asthma-related symptoms, and exercise tolerance, and it inhibited type 2 cytokines extensively, indicating its effectiveness in treating CRSwNP. Tezepelumab was efficacious in these patients and improved their symptoms in terms of comorbidities of the upper and lower airways.
Tezepelumab was effective in treating asthma complicated with CRSwNP recurrence after ESS. However, further studies are required to identify the general and specific roles of tezepelumab in treating severe asthma and recurrent CRSwNP.
tezepelumab是一种抑制胸腺基质淋巴细胞生成素（TSLP）的人IgG2单克隆抗体，已被批准用于治疗重度哮喘。支气管哮喘通常是一种2型炎症性疾病，常与伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）同时发生。然而，tezepelumab对合并CRSwNP的重度哮喘的影响尚不清楚。CRSwNP患者经常是内镜鼻窦手术（ESS）的候选者。CRSwNP是影响哮喘症状的关键因素。然而，一些患者会出现CRSwNP复发。
tezepelumab已被批准用于CRSwNP，且TSLP参与CRSwNP的发病机制。本研究报告了2例重度哮喘合并ESS后CRSwNP复发的患者，tezepelumab迅速改善了哮喘和鼻窦炎症状。
我们根据症状、哮喘加重情况、2型细胞因子水平和肺功能，评估了tezepelumab对重度哮喘合并CRSwNP复发患者的治疗效果。
在接受高剂量吸入性糖皮质激素和长效β受体激动剂治疗后，患者的哮喘仍未得到控制，哮喘控制测试评分较低。然而，tezepelumab减少了重度哮喘加重，改善了肺功能，并控制了哮喘症状。它改善了CRSwNP、哮喘相关症状和运动耐量，并广泛抑制了2型细胞因子，表明其在治疗CRSwNP方面的有效性。Tezepelumab对这些患者有效，并改善了他们上下呼吸道合并症的症状。
Tezepelumab对治疗ESS后CRSwNP复发合并的哮喘有效。然而，需要进一步研究以确定tezepelumab在治疗重度哮喘和CRSwNP复发中的一般和特定作用。
