{
  "abstract": "Introduction Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus fumigatus, predominantly seen in patients with asthma or cystic fibrosis. While systemic corticosteroids remain the mainstay of treatment, their cumulative and long-term use is associated a host of significant adverse effects, prompting the need for more targeted therapies. Monoclonal antibodies have emerged as promising alternatives by modulating key pathways of type II inflammation however, limited published literature exists about the response of ABPA patients to a novel anti-Thymic Stromal Lympopoetin (TSLP) biologic, Tezepelumab.Methods A retrospective, single-centre analysis was conducted on all patients diagnosed with ABPA, as per the revised 2024 ISHAM criteria, who received Tezepelumab for at least 12 months. A clinical response to Tezepelumab was defined as a ≥ 50% reduction in oral corticosteroids (OCS) requiring exacerbations or a reduction in maintenance OCS of at least 50% over a 12-month treatment period. Asthma Control Questionnaire (ACQ-5) scores before and after treatment were also captured.Results A total of 20 patients received Tezepelumab with baseline characteristics listed in table 1. 80% of patients had a clinical response to Tezepelumab at 12 months and 55% had MCID decrease of 0.5 in their ACQ scores at 12 months. There was a significant reduction in annual exacerbation rate from 4.0 (IQR 2.8) to 0.0 (IQR 1.25; p=0.0007, 95% CI −6.24 to −2.30) alongside a significant median ACQ score reduction from 2.17 (IQR 1.50) to 0.84 (IQR 1.46; p=0.0004, 95% CI −1.77 to −0.62). In comparison with a prior biologic study1 conducted at our centre, the reduction in exacerbation rate with Tezepelumab was greater than that observed with anti-IgE therapy (2.0 to 1.0) and comparable to the reductions seen with Mepolizumab (4.0 to 1.0, p<0.0001) and Benralizumab (5.0 to 2.0, p=0.0156).Abstract S163 Table 1 Characteristic Age (y), mean ± SD 60.4 ± 14 Female, n (%) 11 (55%) Ethnicity, n (%)  - White British12 (60%) - White others4 (20%) - Asian British1 (5%) - Not stated3 (15%) BMI, mean ± SD (kg/m2) 28.2 ± 6 Lung function, mean ± SD  - FEV1 (Litres)1.64 ±1  - FVC (Litres)2.75 ± 1 Radiology (descriptive baseline phenotype) (n = 20), n (%)  - Bronchiectasis14 (70%) - Varicose Bronchiectasis4 (20%) - Mucous plugging8 (40%) - Nodules3 (15%) - Consolidation3 (15%) - Mycetoma2 (10%) Serology  - Baseline IgE (IU/L), mean ± SD1532 ± 1623 - Baseline IgE > 1000, n (%)8 (40%) - Peak IgE > 500, n (%)20 (100%) - Baseline Aspergillus-specific IgE (kUA/L), mean ± SD32 ± 51 - Baseline FeNO mean ± SD30 ± 26 Baseline blood eosinophils (× 109/L), mean ± SD 0.36 ± 0.31 No. of patients on mOCS, n (%) 12 (60%) Baseline mOCS dose (mg/d prednisolone), median (IQR) 7.5 (5) Receiving azole therapy, n (%) 13 (65%) Itraconazole6 (30%)Posaconazole4 (20%)Isavuconazole4 (20%Caspofungin1 (5%)Conclusions Overall, Tezepelumab was associated with robust clinical improvement in repeated OCS requirement, including in those on mOCS, which was comparable to, and in some cases, better than other type II monoclonal therapies.Reference Carter, Charlotte, et al. ‘Real-World Effectiveness of Biologic Therapy in Allergic Bronchopulmonary Aspergillosis.’ The Journal of Allergy and Clinical Immunology: In Practice 13. 2025;5:1094–1102.",
  "authors": [
    {
      "affiliations": [
        "Department of Respiratory Medicine, Royal Brompton Hospital, London, UK"
      ],
      "name": "R Sehajpal"
    },
    {
      "affiliations": [
        "Hospital Santa Maria, Lisbon, Portugal"
      ],
      "name": "APS Trindade"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Royal Brompton Hospital, London, UK"
      ],
      "name": "IB Torre"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Royal Brompton Hospital, London, UK"
      ],
      "name": "AM Bucataru"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Royal Brompton Hospital, London, UK"
      ],
      "name": "A Shah"
    },
    {
      "affiliations": [
        "Department of Infectious Disease, Imperial College London, London, UK"
      ],
      "name": "D Armstrong-James"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Royal Brompton Hospital, London, UK"
      ],
      "name": "P Patel"
    }
  ],
  "title": "S163 Managing ABPA with tezepelumab: a single-centre experience",
  "uid": "6d29c8f3-58f6-53c9-a636-4c1770211667"
}