# Case Report: Tezepelumab as rescue therapy in near-fatal asthma requiring extracorporeal membrane oxygenation

## TL;DR

This case report explores the use of tezepelumab in severe asthma patients needing ECMO, showing potential early benefits in lung function.

## Contribution

The paper presents the first reported use of tezepelumab in near-fatal asthma requiring ECMO, suggesting its potential as a rescue therapy.

## Key findings

- Tezepelumab improved tidal volume and minute ventilation within 24–72 hours in three patients.
- All patients were successfully decannulated and weaned off ventilators within 12–28 days.
- No immediate drug-related adverse events were observed, and lung function recovered.

## Abstract

Tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) monoclonal antibody, reduces exacerbations across asthma phenotypes, but its role in status asthmaticus and near-fatal exacerbations requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) is unclear.

We report three patients (17, 22, 57 years) with therapy-refractory hypercapnic respiratory failure initiated on VV-ECMO who received tezepelumab 210 mg within 24 h. Tidal volume and minute ventilation increased within 24–72 h, permitting decannulation by days 12–15 and ventilator weaning by days 17–28. Two patients had elevated IgE; one had normal blood eosinophils/IgE. No immediate drug-related adverse events occurred. Follow-up demonstrated lung-function recovery; one patient required escalation of maintenance therapy for persistent symptoms.

In this small series, adjunctive tezepelumab during VV-ECMO–supported status asthmaticus appeared safe and potentially beneficial adjunctive therapy during near-fatal asthma requiring VV-ECMO. Randomized controlled studies are needed to determine the impact of TSLP inhibition on recovery time, ventilation duration, and mortality in this setting.

Graphical summary of three patients with life-threatening asthma requiring veno-venous ECMO who received a single dose of tezepelumab. Clinical timelines and key events are shown alongside imaging from Case 1 demonstrating resolution of barotrauma between Day 0 and Day 7. Tidal volume increased within the first 24–48 hours after tezepelumab across all cases, with corresponding improvements in minute ventilation during Days 0–6. These observations suggest a potential early physiological benefit of TSLP blockade during severe, refractory asthma exacerbations.Tezepelumab administration and its effects on tidal volume and minute ventilation in severe asthma patients requiring ECMO support are shown. The left section displays a table with basic characteristics and events for three cases: patient age, body surface area, ECMO implantation, and weaning completion. The right section includes two line graphs: the top graph shows tidal volume over time from day zero, while the bottom graph shows tidal volume and minute ventilation from day zero to six, both for three cases. The bottom left shows CT scans for Case 1 on day zero and day seven.

Graphical summary of three patients with life-threatening asthma requiring veno-venous ECMO who received a single dose of tezepelumab. Clinical timelines and key events are shown alongside imaging from Case 1 demonstrating resolution of barotrauma between Day 0 and Day 7. Tidal volume increased within the first 24–48 hours after tezepelumab across all cases, with corresponding improvements in minute ventilation during Days 0–6. These observations suggest a potential early physiological benefit of TSLP blockade during severe, refractory asthma exacerbations.