Tezepelumab in severe asthma: chest computed tomography assessment of airway remodeling and clinical remission

Introduction: Severe asthma is characterized by persistent uncontrolled symptoms despite optimal standard therapy and/or by the need for high-intensity treatment to maintain control. Thymic stromal lymphopoietin (TSLP) is a key innate cytokine that promotes bronchial inflammation in both T2-high and T2-low asthma, thus representing a suitable therapeutic target. Tezepelumab, a human monoclonal antibody designed to block TSLP, has been shown to be able to dampen airway inflammation and improve patients’ symptoms and overall outcomes. Methods: This study evaluated the effectiveness of tezepelumab in patients with severe asthma in a real-world clinical setting, examining its capacity to induce clinical remission and improve radiological markers of disease. Twenty patients with severe uncontrolled asthma received subcutaneous tezepelumab at a dose of 210 mg every 4 weeks. Clinical, functional, biologic, and radiological data were collected at baseline and after 12 months of treatment. Results: The results showed a significant increase in Asthma Control Test (ACT) score, from baseline 11.70 ± 1.78 to 20.15 ± 1.38 (p < 0.0001). Oral corticosteroid (OCS) intake decreased from 12.50 mg/day (5.00–25.00) to 0.00 mg/day (0.00–3.75) (p < 0.0001), and the rate of yearly exacerbations lowered from 2.0 (2.0–3.0) to 0.0 (0.0–1.0) (p < 0.0001). There was also a notable increase in pre-bronchodilator forced expiratory volume in 1 s (FEV1), from baseline 57.15% ± 17.18% to 66.35% ± 18.09% (p < 0.001). Clinical remission was achieved by 30% of patients, while 55% reached partial remission. Radiologically, the Mucus Plug Score (MPS) decreased from 5.36 ± 2.85 to 3.94 ± 2.69 (p < 0.0001), and radiological metrics showed inverse correlations with functional parameters. In simple logistic regression analysis, lower MPS values at baseline and at follow-up were significantly associated with higher odds of achieving complete clinical remission at 12 months of add-on tezepelumab therapy. Conclusion: In summary, tezepelumab induced significant benefits in patients with severe asthma in this real-world cohort, improving symptoms, lung function, and radiological outcomes.