Real-life preliminary evidence for basophils as predictors of Tezepelumab response in severe asthma

Background: Severe asthma is a complex disease with persistent symptoms despite high-dose inhaled therapy. Tezepelumab, a monoclonal antibody targeting thymic stromal lymphopoietin (TSLP), has shown efficacy across asthma phenotypes. However, identifying early responders remains a challenge. Basophils, key players in type 2 inflammation, may serve as predictive biomarkers. Objective: We evaluated the presence of super-responder status after six months of Tezepelumab therapy and explored the predictive role of blood basophil levels. Methods: A real-life, prospective study was conducted on 16 severe asthma patients. Super-responders were defined per Upham et al.’s criteria, adapted for a six-month assessment. Clinical, functional, and inflammatory parameters, including blood basophil counts, were analyzed. Results: After six months, 62.5% of patients achieved super-responder status, with complete exacerbation elimination, reduced oral corticosteroid use, and improved asthma control. A significant logarithmic association (p = 0.019) was found between baseline basophil levels and super-responder status, indicating that higher basophil counts were associated with an increased likelihood of super-response. This finding was supported by a trend toward significance in ROC curve analysis (AUC = 0.800, p = 0.050), suggesting potential predictive value. Conclusion: Tezepelumab demonstrates early efficacy in severe asthma, and baseline blood basophil levels may represent a promising biomarker for response prediction.