Over the course of 12 years, I’ve been on and off 4 different biologics medications for asthma. The longest I’ve been on any single biologic is 14 months, that would be Zolair. The second longest is Benralizumab (Fasenra) at 10 months, followed by Dupilumab (Dupixent) at 3 months and the most recent, Tezepelumab (Tezspire) at just one month.
The reason for stopping each of these, except for Fasenra, varies, but essentially, they either didn’t help, they had side effects I didn’t like, or they seemed to make my asthma worse. It’s difficult to tell sometimes if a particular drug is working. Your PFT numbers might look better, you’re experiencing less severe flares, but you still feel like crap. Other times the response to these drugs more obvious.
Case in point, after doing reasonably well on Fasenra for 9 months, we thought that because I have a lot of mast cells in my airways, that adding Tezspire to the mix might offer better coverage. For a 2-month period I had both of these biologics in my system at the same time. But for some unknown reason, less than a day after adding the Tezspire, I developed what is known as rebound asthma, where my symptoms actually got worse. My asthma got so bad that I had I actually to restart and stay on prednisone for 6 weeks. That’s the longest I’ve been on oral steroids since weaning completely off them earlier this year.
So what happened? Could it be that one of the drugs was somehow inferring with the action of the other? No one really knows. My flare up may have been a random event, a coincidence that had nothing to do with either of the drugs, but the timing was suspicious and rather than risk getting sicker, we decided to stop further Tezspire injections. You would think that with 2 biologics on board youd have double the protection, but for the 4 to 8 weeks it was in my system I obviously didn’t.
All of these drugs work differently. Zolair works by preventing IgE from attaching to mast cells and binding to allergens. Dupixent and Fasenra make changes to your immune to lower the number of eosinophils in the blood in patients with eosinophilic asthma. They work by blocking the actions of certain proteins called interleukins, which are produced by white blood cells to regulate immune responses. In this case IL-4 and IL-5 respectively. Tezspire works differently by targeting a molecule called thymic stromal lymphopoietin or TSLP, which is responsible for inflammation in the airway. Tezspire stands out from the others, in that it seems to help those with all types of severe asthma, not just eosinophilic asthma.
With so many choices out there these days, which one, if any, is the right biologic for you? All of these drugs, if they act on your specific type of asthma, have been shown to decrease the frequency of attacks, reduce the need for corticosteroids and improve one’s overall quality of life. I can only speak from own experience, but so far, Fasenra has worked the best for me. I say that because Ive been on the drug now for almost a year, and while I to continue to have occasional flare ups and even a brief hospital stay a couple months ago, I havent been intubated or what I would consider to be in critical condition with my asthma in nearly 10 months…that’s pretty amazing for me.
Going forward, if the current Fasenra winning streak extends to a full year or beyond, I think that will be enough to convince me that the drug is working. On the other hand, if I have a really bad exacerbation before then and wind up in the ICU, I’ll have to seriously reconsider whether I want to continue taking ANY of these drugs. They’re incredibly expensive, and not always panacea that one might hope for. Though considered safe, we really don’t know much about the long-term effects of these drugs. One thing we do know for sure, is that the long-term effects of steroids and uncontrolled asthma is not good.
Doing better as judged by fewer severe flares and hospitalizations, but