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Alan Khadavi, MD, APC
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March 13, 2023 by Alan Khadavi

Tezspire vs. Nucala vs. Fasenra vs. Dupixent for Eosinophilic Asthma, a comparison

With the influx of new biological medications for asthma, the question is which one is the best to use in comparing Tezspire, Nucala, Fasenra and Dupixent? In many individuals, asthma remains uncontrolled despite the use of inhaled steroids, the use of new biological injections can improve symptoms greatly.

There are no head to head trials comparing the above 4 therapies together. In a past blog post we discussed 3 of them, but it did not include Tezspire which was FDA at the end of 2021.

Nucala, Fasenra or Dupixent for Severe Eosinophilic Asthma?

A recent study performed a meta-analyses to compare Tezspire to Dupixent, Fasenra and Nucala. To refresh your knowledge about each individual one, you can read our blog posts below.

Tezspire Tezepelumab for Severe Asthma

New Asthma Drug Nucala (Mepolizumab) for Severe Eosinophilic Asthma

Fasenra (Benralizumab) for Severe Asthma

How does Dupixent work?

The authors of the paper pooled various studies to compare the effectiveness of dupilumab (Dupixent), benralizumab (Fasenra), mepolizumab (Nucala) and tezepelumab (Tezspire). Ten randomized controlled trials met eligibility.  A few conclusions were drawn from these studies.

  • Tezspire was associated with significantly lower exacerbation rates than Fasenra and larger improvements in FEV1 compared to Nucala and Fasenra.
  • Nucala improved the Asthma Control Questionnaire score the most, but this improvement was not significantly different from that of Tezspire.
  • For efficacy by clinically important thresholds, Tezspire, Nucala and Dupixent achieved a 99% probability of reducing exacerbations rates by half, compared to placebo, but Fasenra only had a 66% probability of doing so.
  • Tezspire and Dupixent had better chance of improving FEV1 above placebo.
  • Compared to Nucala, Dupixent had a greater of improving the FEV1, but the difference was small.

The authors concluded in the study, that in individuals with eosinophilic asthma, Tezspire and Dupixent were associated with greater improvements (although below clinical thresholds) in exacerbation rates and lung function than Fasenra or Nucala.

There are major limitations of this study as these are not head to head, but indirect comparisons. Every patient is their own individual with their own circumstances and you can not always make generalized comparisons. But based on the amount of patients they included overall their conclusions were that in patients with eosinophilic asthma and eosinophil counts over 300 cells/microliter, Tezspire and Dupixent had better efficacy outcomes than Fasenra and Nucala. However, many of the statistically significant differences were below the Minimally clinical important difference (MCID) for exacerbation rates and prebronchodilator FEV1.

This article was adapted from The Journal of Allergy and Clinical Immunology, March 2023, Volume 151, Issue 3, pages 747-755.

Filed Under: Asthma, biologics, Blog

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Dr. Alan Khadavi
Allergy & Asthma Specialist

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