2 biologics on board and I still got sick…WTF?

On July 1st, 2022, I received my first dose of Tezspire (Tezepelumeb). This is now the 4th asthma biologic Ive been on. Tezspire is a new anti TSLP drug that works much differently than other asthma biologics. Prior to this I was on Fasenra (Benarilzumab) and was doing well on it, but my Pulmonologist thought that Tezspire might work even better for me, as early studies has shown promising results in both the Th2 high and Th2 low asthma populations. I fit into the Th2 low group, as I don’t have the usual biomarkers seen in severe asthma that would indicate airway inflammation, ie high eosinophil counts or high FENO levels etc. Tezspire also appeared to work better in asthmatics who have lots of mast cells in their airways, I fit into that group as well, maybe even to a greater degree than many.

A month earlier on June 1st, I received my final bi-monthly injection of Fasenra, which stays active in your system for about 120 days after the last dose. So now theoretically, with two biologics in my body, each one working in different ways, I should have double the protection for at least the next 3 months. Imagine, the possibly of no flares at all for an entire 3 months! Wouldn’t that be wonderful.

Ah, but leave it to good ole “Steve Asthma“, less than 48 hours after receiving that first dose of Tezspire, I started flaring again…big time. None of my symptoms were consistent with the known serious side effects or anaphylaxis. But still, the timing was kind of suspicious. After all, this is a brand-new drug and thorough clinical trials or not, there’s no way to know for sure what kind of side effects might emerge down the road a few years down the road in different people. Maybe my body didn’t like having 2 different biologics onboard at the same time, though it would probably have taken a couple weeks for the second drug to kick in. Nah, I’m pretty sure it’s just coincidence that I started flaring after that first shot. I know I was naive for thinking this way, but I had such high expectations for some kind of instant dual protection. Fasenra alone, worked so well for me that I was able to completely come off daily prednisone for nearly 7 months. Now Im forced to take them again or risk ending up super sick.

This story isn’t quite finished yet, as this current flare is still evolving. My symptoms have been bouncing from mildly uncomfortable, to ones that could easily buy me a ticket to the Intensive Care Unit, or worse. And as I mentioned above, I had to reluctantly and grudgingly restart the oral steroids just stay afloat. Talk about a feeling of defeat. But you got to do what you gotta to prevent a flare from spiraling out of control, right? I’ll let you know how things turn out, hopefully this flare was an aberration, a one-off.

Despite this little glitch or setback, I still have high hope that Tezspire will do good things for me in the future. Just prior to my first injection we did some baseline PFTs and Impulse Oscillometry and will repeat them every few months while Im on the drug to see if there’s any improvement in my pulmonary function numbers. That, along with subjective input by me as to how Im feeling, should really help to determine how effective the drug is for me. As you can see, right now my numbers are pretty dismal, so even the slightest upward bump would be great.

I guess the point of this post is to remind people, that while asthma biologics are an amazing new tool in the fight against certain types of severe asthma, they’re not a panacea. They’re considered add-on therapies that might improve one’s asthma control and help reduce dependency on oral steroids. I think the sobering fact is, most of us with really severe asthma are still going to experience exacerbations while on biologics, and some of those exacerbations might be severe. But if you’re one of the lucky ones who responds to these drugs, you’ll hopefully experience much longer periods of good breathing in between those flares.

Update: It took two 5-day rounds of prednisone, but I managed to avert a hospital stay. I now seem to be over the hump and am currently weaning off the roids. As of today, my 8-months of no intubations for asthma record, remains intact. Fingers crossed for another 8 months!

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