The PEACE-24 study: Tezepelumab improves exercise tolerance and symptoms control in severe asthma

Background: Tezepelumab is effective in improving disease control and reducing exacerbations, regardless of the T2 inflammatory profile 1-5. With its ability to mitigate bronchial hyperresponsiveness and mucus hypersecretion, improve respiratory function, and modulate the inflammatory response 1,6,7, this drug could play a role in increasing exercise tolerance. Objective: Our study aims to evaluate the improvement in exercise tolerance, a less-explored aspect, in patients treated with Tezepelumab using the 6-min walking test (6 MW T). Methods: Patients treated with Tezepelumab at Respiratory and Allergy Clinic of Genoa Metropolitan Hospital were included in the study. Patients were assessed at baseline and at 24 weeks using spirometry, exhaled nitric oxide measurement, asthma control and quality of life questionnaires (ACT, AQLQ, SNOT22, RAPP), and 6 MW T. Pre- and post-treatment data were analyzed using the paired samples t-test and Spearman's correlation. Results: After 24 weeks, a significant improvement was observed in the distance covered in the 6 MW T, both in absolute terms (409m vs. 478m, p = 0.031) and in terms of % of the predicted theoretical value (73% vs. 82%, p = 0.034), with improvement in pre-test dyspnea (Borg 3.55 vs. 1.47, p = 0.002) and the average score of the domains related to physical exercise in the AQLQ questionnaire (4.24 vs. 5.80, p = 0.01). There was also a positive correlation between improvement in FEV1 and distance covered (ρ = 0.658, p = 0.028). Conclusion: Tezepelumab, with its effects, increases exercise tolerance in patients with severe asthma, highlighting this as a potentially treatable trait to consider in the management of such patients.