Research Summary

Can Tezepelumab Improve Rhinosinusitis Symptoms, Asthma Control in Patients with Severe Asthma and a History of Nasal Polyps?

Anthony Calabro, MA

Key Highlights

  • Tezepelumab improved total Sino-Nasal Outcome Test (SNOT)-22 scores versus placebo over 52 weeks in patients with severe asthma and a history of CRSwNP.
  • Improvements were seen across all five SNOT-22 domains and key individual symptoms, including smell/taste, nasal blockage, and sleep quality.
  • Tezepelumab also reduced exacerbations, improved lung function, and enhanced asthma control compared with placebo.

Tezepelumab demonstrated sustained and clinically meaningful improvements in rhinosinusitis and asthma-related symptoms in patients with severe, uncontrolled asthma and a history of chronic rhinosinusitis with nasal polyps (CRSwNP). Compared with placebo, tezepelumab reduced Sino-Nasal Outcome Test (SNOT)-22 scores across the study’s 52-week duration, with additional benefits seen in asthma exacerbation rates, lung function, symptom control, and quality of life.

Chronic rhinosinusitis with nasal polyps is a comorbid condition that involves long-term inflammation of the nasal passages. Prior analyses from the NAVIGATOR trial suggested tezepelumab may improve both asthma and rhinosinusitis outcomes, but a more granular assessment of specific symptom domains had not been previously conducted until this post hoc analysis conducted by Joshua S. Jacobs, MD, and colleagues, which included patients aged 12 to 80 years with severe, uncontrolled asthma who were randomized to tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks.

This patient population included individuals with a history of CRSwNP at any time before enrollment. The primary efficacy endpoint in NAVIGATOR was the annualized asthma exacerbation rate; secondary outcomes included pre-bronchodilator forced expiratory volume in 1 second (FEV₁), Asthma Control Questionnaire-6, Asthma Quality of Life Questionnaire, and Asthma Symptom Diary scores. For this analysis, investigators assessed SNOT-22 total, domain, and key symptom item scores.

Of the 1059 patients enrolled in NAVIGATOR, 165 (15.6%) had a history of CRSwNP. Compared with placebo, tezepelumab produced sustained reductions in total SNOT-22 scores over 52 weeks [least-squares mean difference, -11.08; 95% CI, -17.80 to -4.35]. Improvements were seen across all five SNOT-22 domains—sleep, nasal, function, ear/facial, and emotion—as well as in the five key items deemed most clinically relevant: decreased sense of smell/taste, nasal blockage, reduced productivity, waking up tired, and cough. The magnitude of improvement was consistent with clinically meaningful benefit.

Tezepelumab also improved asthma-related endpoints in patients both with and without a history of CRSwNP, including reduced exacerbation frequency, increased FEV₁, better symptom control, and improved health-related quality of life.

The study’s limitations include its post hoc design, which was not powered to assess tezepelumab’s efficacy specifically in patients with CRSwNP. Additionally, CRSwNP status was based on medical records without baseline endoscopic confirmation or objective measurement of polyp size. Finally, SNOT-22 scores were collected only at weeks 28 and 52, limiting insight into the timing of symptom improvements.

“In patients with severe, uncontrolled asthma and a history of CRSwNP, tezepelumab improved rhinosinusitis symptoms across multiple domains, as well as asthma exacerbations, lung function, asthma control, and health-related quality of life,” Jacobs and colleagues concluded.

Reference
Jacobs JS, Han JK, Lee JK, et al. Effect of tezepelumab on sino-nasal outcome test (snot)-22 domain and symptom-specific scores in patients with severe, uncontrolled asthma and a history of chronic rhinosinusitis with nasal polyps. Adv Ther. 2024;41(12):5341-5356. doi:10.1007/s12325-024-03006-5.