Navigating Advanced Asthma Therapies: Tezspire vs. Dupixent
Severe asthma poses significant challenges, often uncontrolled by standard inhaler therapies [1.6.1]. For this patient population, biologic medications like Tezspire (tezepelumab-ekko) and Dupixent (dupilumab) represent a major advancement in treatment. However, determining which is 'better' is not a simple question; it's a complex decision based on individual patient characteristics, the specific type of inflammatory pathway driving their asthma, and other health conditions. There is no clear evidence from head-to-head clinical trials that one is definitively superior to the other overall [1.2.2, 1.8.1].
Understanding Tezspire (tezepelumab-ekko)
Tezspire is a newer biologic medication, FDA-approved in December 2021, for the add-on maintenance treatment of severe asthma in adults and pediatric patients aged 12 years and older [1.6.1, 1.13.3]. Its groundbreaking feature is its mechanism of action.
Mechanism of Action
Tezspire is a first-in-class thymic stromal lymphopoietin (TSLP) blocker [1.2.3, 1.4.2]. TSLP is an upstream cytokine, or signaling protein, released by epithelial cells in the lungs in response to triggers like allergens and viruses [1.4.1]. This protein initiates a broad inflammatory cascade. By blocking TSLP at the top of this cascade, Tezspire can reduce a wide range of inflammatory biomarkers and cells, regardless of a patient's specific eosinophil or allergen status [1.4.4, 1.3.1]. This makes it effective for a broad population of severe asthma patients, including those with non-eosinophilic (non-type 2) asthma who previously had limited biologic options [1.3.2, 1.13.2]. It is administered as a subcutaneous injection once every four weeks [1.6.3].
Understanding Dupixent (dupilumab)
Dupixent, FDA-approved for asthma in 2017, has a more targeted approach and is approved for a wider range of inflammatory conditions [1.13.3, 1.2.1]. For asthma, it's indicated as an add-on maintenance treatment for patients aged 6 and older with moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma [1.7.3].
Mechanism of Action
Dupixent is an interleukin inhibitor, specifically targeting the shared receptor for both Interleukin-4 (IL-4) and Interleukin-13 (IL-13) [1.5.4]. These two cytokines are key drivers of type 2 inflammation, the pathway underlying eosinophilic and allergic asthma [1.3.1, 1.5.2]. By blocking IL-4 and IL-13 signaling, Dupixent effectively reduces the hallmarks of type 2 inflammation, such as high eosinophil counts and fractional exhaled nitric oxide (FeNO) levels [1.5.3, 1.2.2]. Its dosage can vary from every week to every four weeks depending on the condition being treated [1.2.3]. Beyond asthma, Dupixent is also approved for conditions like atopic dermatitis (eczema), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic esophagitis (EoE), and others [1.7.2, 1.7.3].
Direct Comparison: Tezspire vs. Dupixent
| Feature | Tezspire (tezepelumab-ekko) | Dupixent (dupilumab) |
|---|---|---|
| Mechanism | Blocks Thymic Stromal Lymphopoietin (TSLP), an upstream mediator of inflammation [1.4.2]. | Blocks the shared receptor for Interleukin-4 (IL-4) and Interleukin-13 (IL-13), key drivers of Type 2 inflammation [1.5.4]. |
| Asthma Indication | Add-on maintenance for severe asthma in adults and children 12+ years old [1.6.2]. | Add-on maintenance for moderate-to-severe eosinophilic or oral steroid-dependent asthma in adults and children 6+ years old [1.7.3]. |
| Target Population | Broad range of severe asthma, including non-type 2 inflammation (low eosinophils) [1.13.2]. | Primarily patients with Type 2 inflammation (high eosinophils or FeNO) [1.2.2]. |
| Other FDA-Approved Uses | Currently only severe asthma [1.13.3]. | Atopic dermatitis, CRSwNP, Eosinophilic Esophagitis, Prurigo Nodularis, COPD, and Chronic Spontaneous Urticaria [1.7.2, 1.7.3]. |
| Administration | 210 mg subcutaneous injection every 4 weeks [1.6.3]. | Subcutaneous injection every 1 to 4 weeks, depending on the indication [1.2.3]. |
| Common Side Effects | Sore throat, joint pain, back pain [1.9.4]. | Injection site reactions, eye problems (redness, itching, dry eyes), high eosinophil counts, sore throat [1.10.1, 1.10.4]. |
Efficacy, Safety, and Choosing the Right Medication
Since no direct head-to-head trials have definitively compared the two, choosing between them involves clinical judgment. An indirect comparison analysis suggested long-term dupilumab treatment might lead to a lower rate of exacerbations and greater lung function improvement compared to tezepelumab in matched groups, though the study noted its own limitations and called for direct trials [1.8.3].
- For Patients with High Eosinophils (Type 2 Asthma): Both drugs are effective. Dupixent specifically targets the IL-4/IL-13 pathway central to this phenotype [1.3.1].
- For Patients with Low Eosinophils (Non-Type 2 Asthma): Tezspire is the only biologic approved for all types of severe asthma without biomarker limitations, offering a crucial option for this group [1.6.4, 1.13.2].
- For Patients with Other Allergic Conditions: If a patient has severe asthma and also suffers from atopic dermatitis or CRSwNP, Dupixent might be a preferred choice due to its multiple approved indications [1.13.3].
Safety profiles are also a consideration. While both are generally well-tolerated, Dupixent is more commonly associated with eye-related side effects like conjunctivitis, while Tezspire's most common side effects include sore throat and joint pain [1.13.1, 1.9.3, 1.9.4, 1.10.2]. Both carry a risk of serious allergic reactions [1.2.3].
Conclusion: A Personalized Decision
The question of whether Tezspire is better than Dupixent has no universal answer. Tezspire offers a broader mechanism for all severe asthma types, while Dupixent provides targeted action for type 2 inflammation and covers a wider array of related allergic diseases. The best choice is a highly personalized one, made in close consultation with a healthcare provider who can assess the patient's specific asthma phenotype, biomarker levels, co-existing conditions, and treatment goals.
For more information on biologics for asthma, consult the Asthma and Allergy Foundation of America.
