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 approved at the end of 2021.
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.
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. All of the medications have shown to significantly reduce patients’ exacerbations and reduce the need for oral steroid (prednisone) use.
This article was adapted from The Journal of Allergy and Clinical Immunology, March 2023, Volume 151, Issue 3, pages 747-755.
Another study showed that Tezspire substantially reduced all asthma outcomes compared to placebo, although all of these biological medications have a much greater effect than placebo. All of them reduce them reduce the burden of disease in severe uncontrolled asthma. Every patient needs to have individualized, personal care to see which biological is right for them.
Update January 15, 2024
A recent study showed that patients who had taken mepolizumab (Nucala) or reslizumab (Cinqair) for eosinophilic asthma who did not respond, saw benefit from switching to Fasenra. Benralizumb effectively depleted both sputum and peripheral eosinophils and reduced biomarkers of type 2 inflammation. Improved disease control was observed in 80% of subjects. Because Fasenra depletes eosinophils and other IL5R-expressing cells such as the ILC2s by inducing antibody-mediated cellular cytoxicity by natural killer cells in addition to inhibiting IL-5 signaling. (American Journal Respiratory Critical Care, 2023 Oct. 12).