1 Recommendations

1.1 Tezepelumab as an add-on maintenance treatment is recommended as an option for severe asthma in people 12 years and over, when treatment with high-dose inhaled corticosteroids plus another maintenance treatment has not worked well enough. It is recommended only if people:

have had 3 or more exacerbations in the previous year, or
are having maintenance oral corticosteroids.

Tezepelumab is recommended only if the company provides it according to the commercial arrangement.

1.2 Stop tezepelumab if the rate of severe asthma exacerbations, or the maintenance oral corticosteroid dose, have not been reduced by at least 50% at 12 months.

1.3 These recommendations are not intended to affect treatment with tezepelumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. For young people, this decision should be made jointly by them, their clinician, and their parents or carers.

Why the committee made these recommendations

Severe asthma is usually treated with inhaled corticosteroids plus another maintenance treatment. Oral corticosteroids are sometimes used to prevent exacerbations (asthma attacks), but they may have negative effects in the long-term. Some people with severe asthma can have biological treatments. Tezepelumab is another biological treatment.

Clinical trial results show that tezepelumab, when added to usual treatment, reduces exacerbations and the dose of oral corticosteroids needed, compared with placebo. An indirect comparison of tezepelumab with other biological treatments suggests similar clinical effectiveness, but this is uncertain.

The cost-effectiveness estimates show that tezepelumab as an add-on maintenance therapy is cost effective compared with standard care and other biological treatments. So, tezepelumab is recommended when treatment with high-dose inhaled corticosteroids plus another maintenance treatment has not worked well enough, for people who have had 3 or more exacerbations in the previous year or who are having maintenance oral corticosteroids.