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Introduction and Objectives Chronic rhinosinusitis (CRS), with nasal polyps (CRSwNP) or without NP (CRSsNP), is commonly associated with severe asthma. In the phase 3b WAYFINDER study of tezepelumab in oral corticosteroid (OCS)-dependent patients with severe asthma ( NCT05274815), most patients achieved clinically meaningful reductions in maintenance OCS (mOCS) dose to ≤ 5 mg/day, or discontinued OCS, while maintaining asthma control. This post hoc analysis evaluated OCS reduction and sino-nasal symptoms in WAYFINDER participants with comorbid CRS, both overall and with NP only.Methods WAYFINDER was an open-label, single-arm, OCS-sparing study in adults with severe asthma receiving mOCS (prednisone/prednisolone 5–40 mg/day or equivalent) for ≥ 3 months before study entry. Patients with CRS (CRSwNP or CRSsNP) or CRSwNP only, received tezepelumab 210 mg subcutaneously every 4 weeks for up to 52 weeks. After a 4-week induction phase on a stable OCS dose, patients entered a 48-week OCS reduction and maintenance phase. The co-primary endpoints, assessed at weeks 28 and 52, were the proportions of patients who 1) reduced their daily prescribed mOCS dose to ≤ 5 mg/day without loss of asthma control; and 2) discontinued OCS without loss of asthma control. For this analysis, the co-primary endpoints, change from baseline in Sino-Nasal Outcome Test (SNOT)-22 total score, and SNOT-22 response (total score decrease from baseline of ≥ 8.9 [MCID]) were assessed at weeks 28 and 52.Results Of 298 patients who received tezepelumab in WAYFINDER, 74 (24.8%) had CRS and 36 (12.1%) had CRSwNP. By week 52, 87.8% and 91.7% of patients in the CRS overall and CRSwNP groups, respectively, had an mOCS dose of ≤ 5 mg/day, while 45.9% and 50.0%, respectively, had discontinued OCS. Mean SNOT-22 total score improved by 15.7 and 18.9 in the CRS overall and CRSwNP groups, respectively, at week 52, and 50.0% and 55.6% of patients, respectively, were classified as SNOT-22 responders ( figure 1).Abstract P198 Figure 1Conclusions Tezepelumab enabled patients with severe asthma and CRS (with or without NP) to reduce or discontinue their mOCS use, while improving sino-nasal symptoms. These data contribute to the growing evidence of the efficacy of tezepelumab in patients with CRS, including CRSwNP.