Successful switch to tezepelumab for severe asthma and chronic rhinosinusitis with nasal polyps.

Abstract

Chronic rhinosinusitis with nasal polyp (CRSwNP) is a type 2 inflammatory disease frequently associated with asthma. Patients with CRSwNP are typically treated with endoscopic sinus surgery and oral corticosteroids. However, they often experience recurrence; in addition, oral corticosteroids have several adverse effects. CRSwNP is an important factor influencing asthma control, and total control of both CRSwNP and asthma is important for treatment. Dupilumab and mepolizumab, which are anti-interleukin (IL)-4R and anti-IL-5 monoclonal antibodies, respectively, have been approved for the treatment of severe asthma and CRSwNP. Here, we discuss the successful treatment of a patient with severe asthma comorbid with CRSwNP after switching from dupilumab and mepolizumab to tezepelumab. The patient was initially treated with high-dose inhaled corticosteroids/long-acting β2-agonist/long-acting muscarinic antagonist treatment, without success. Treatment with dupilumab improved asthma and CRSwNP; however, it later induced hypereosinophilia with exacerbated asthma. Although subsequent treatment with mepolizumab improved asthma, the nasal symptoms recurred. After attempting dupilumab treatment again, the nasal symptoms improved; however, the asthma symptoms worsened parallel with an increased eosinophil count. Finally, the antithymic stromal lymphopoietin monoclonal antibody tezepelumab, was selected for treatment; the worsening asthma symptoms then improved with the control of CRSwNP. This report illustrates the potential utility of tezepelumab for the treatment of asthma and CRSwNP. Tezepelumab therapy may enhance total control of comorbidities of both the upper and lower airways. Further studies are required to identify effective therapies for asthma and CRSwNP.