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Tezepelumab Broadest Biologic — RACP Adult Medicine MCQ

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HardRespiratoryTezepelumab Broadest BiologicRACP Adult Medicine

A 45-year-old woman with severe asthma (both eosinophilic and allergic phenotype) has elevated eosinophils (500 cells/μL), elevated IgE (450 IU/mL), positive skin prick tests to multiple aeroallergens, and elevated FeNO (65 ppb). She has failed Step 4 therapy. Which biologic has the broadest Type 2 coverage?

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Correct answer: A — Anti-TSLP (blocks epithelial alarmin)

Tezepelumab (anti-TSLP) targets thymic stromal lymphopoietin — an upstream epithelial alarmin that drives multiple Type 2 pathways (IL-4, IL-5, IL-13, IgE). It has the broadest Type 2 anti-inflammatory effect and reduces exacerbations regardless of baseline eosinophil count (NAVIGATOR trial). Dupilumab (anti-IL4Rα) also has broad Type 2 coverage (blocks both IL-4 and IL-13 signalling). For overlapping allergic/eosinophilic phenotype, dupilumab or tezepelumab provides broadest coverage.

Reference: GINA – 2024 – Biologics; NAVIGATOR Trial; Australian Asthma Handbook 2024