Tezspire/tezepelumab for bronchiectasis ro reduce steroid intake

@spectrumcyclist Yes, Tezspire is a fairly recent medication in the biologic class, used to treat severe asthma. I have heard it being advertised on TV recently, and it was suggested to someone in the family to manage their difficult to treat asthma. Insurance has rejected it due to high cost and short time on market.
Certainly those of us who are steroid-dependent for managing our asthma or other conditions would love a safer long-term alternative.
The drawback is the high cost - approximately $4500 per injection, 13 times per year. Insurance and Medicare are understandably reluctant to approve it if any other, less costly, option works. And based on my experience, they would be even more unlikely to approve it for an off-label use. There may be payment assistance available for up one year.
Another concern is the long-term safety and effectiveness of many biologics. A different family member was an early user of one of them, and now, after about 8-10 years it no longer works, and they are back to square one trying to find a new treatment.
It would be an interesting question to ask your provider.

I am currently on Teszpire and in a week will administer my fourth injection. I have severe asthma, bronchiectasis (modulated CF Gene), and Pseudomonas. I live just outside Toronto and attend the adult CF Clinic in Toronto. My specialist sent me to another specialist to see if I was a candidate for Dupixent; the thought was that my severe asthma may be caused by allergies. Due to the pseudomonas, I have tried several inhaled antibiotics, but I always end up having wheezing and worsening breathing. Long story short, when I saw the specialist, he advised that I don't have allergies (after testing), but triggers to my asthma (dust, pollen, dander). He decided to try me on Teszpire as this injection directly blocks thymic stromal lymphopoietin (TSLP), a cytokine released early in inflammatory cascades by airway epithelial cells. If you've read all of the literature, you will know about this. As I go into my fourth injection, here is how it has affected me so far: I am walking faster on the treadmill than I ever have without taking breaks to catch my breath, I am not getting short of breath as often as before (my whole life), and I'm also not coughing as much. So far, the only side effect I have noticed, and this may not be related to the injection, is that one of my calves is a bit fuller than normal, and it feels as if it is slightly swollen. I have contacted the Dr. and he is going to see me before my next injection to rule out anything else. They do monitor you on this injection, which makes me feel safe. I have not stopped any of my inhaled puffers, currently taking Advair, Flovent, Spiriva Respimat, as well as Singulair once daily. I take the Ventolin puffer prior to my hypertonic saline, and I have been able to reduce that to two puffs from four. Anyway, hope this is helpful. I will post again after my next injection and the visit with my Dr. to provide any updates that would be helpful.

@sueinmn which biologic did your family member use that stopped working ?

@cholash I think it was Xolair - they were a very early user, beta testers, as a Mayo Patient - over 10 years ago. Back to studying and trying to find what is next.

I’ve been on Xolair for couple of years . I didn’t realize it could become ineffective .

@cholash I think the situation has even some Mayo docs puzzled, but even with Xo.air my family member wasn't completely symptm free.

I think various biologics can become ineffective. I have been on Humira for going on 8 years for Crohn's disease, so far successfully. Periodically my GI doc does blood work for the medication levels. What happens is your body can start to create antibodies to the medication. I don't know if this applies to all biologics. In my own case, even if the Humira started to lose effect, I am happy I have had this many years in almost-complete-remission and would be ready to start the next go at treatment. (As of this year, I have started a bio-similar -- my insurance (and my doc tells me a lot of insurances) stopped covering Humira because the bio-similar now has a safe and effective good track record and is phenomenally cheaper.