Is Tezspire (Tezepelumab) effective in treating eosinophilic esophagitis?

Question

Hello doctor,

A 29-year-old male patient with severe eosinophilic asthma and concurrent eosinophilic esophagitis (EoE) is being considered for Tezspire. Asthma is uncontrollable with frequent exacerbations despite maximal inhaled therapy (high-dose ICS/LABA, Tiotropium) and daily Montelukast. The blood eosinophil count is 950 cells/μL. Gastroenterologists follow EoE with persistent dysphagia despite PPI and topical steroid therapy. A recent esophageal biopsy shows greater than 30 eosinophils/hpf. Previously failed dietary management. Pulmonary function tests show moderate obstruction (FEV1 65 %) with significant bronchodilator response. No previous biologic therapy trials. The last endoscopy showed rings and furrows typical of active EoE. Recent asthma exacerbation required a 10-day Prednisone course with temporary improvement in both conditions. What is known about Tezspire's efficacy in EoE? Would this be considered an on-label or off-label dual indication? What are the monitoring recommendations for both conditions?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Tezspire (Tezepelumab) and EoE (eosinophilic esophagitis):

Tezspire is FDA -(Food and Drug Administration) approved for severe asthma but not for eosinophilic esophagitis, making its use for EoE off-label. Unlike Dupilumab (which targets interleukin-4 and interleukin-13), Tezepelumab blocks TSLP (thymic stromal lymphopoietin), an upstream cytokine that drives eosinophilic inflammation. Limited data exists on Tezspire’s efficacy in eosinophilic esophagitis, but case reports suggest possible benefits, especially in patients with both asthma and eosinophilic esophagitis. However, Tezepelumab does not directly lower eosinophil counts, so its impact on eosinophilic esophagitis symptoms is uncertain.

Dual indication use:

On-label for asthma due to severe eosinophilic phenotype and frequent exacerbations.
Off-label for eosinophilic esophagitis, as it is not yet FDA-approved for this condition.

Monitoring recommendations:

Asthma:

Take spirometry every three to six months to track lung function.
Monitor for exacerbations and symptom control.
Check blood eosinophils periodically (though Tezspire does not always lower them).

Eosinophilic esophagitis:

Monitor dysphagia symptoms closely.
Consider repeating endoscopy with biopsy every three to six months to assess response.
Continue PPI (proton pump inhibitors)or topical steroids as needed since Tezspire may not fully control EoE.
If eosinophilic esophagitis symptoms persist, Dupilumab might be a better option, as it is FDA-approved for both asthma and EoE. Let me know if you need further guidance.

I hope this helps.

Thank you and take care.

Regards.