An international clinical trial has suggested that a monthly injection could allow people with severe asthma to stop taking daily steroid tablets altogether – or at least reduce their intake, with no ill effects, reports The Guardian.
More than 260m people are thought to have asthma worldwide, and while most can control it with inhalers to treat immediate symptoms and preventive ones to reduce inflammation, those with the most severe asthma often take daily doses of oral corticosteroids as well.
But serious health conditions – including osteoporosis, diabetes and increased vulnerability to infections – have been linked to long-term use.
A major international clinical trial, however, has found that people who received injections of tezepelumab every four weeks were able to reduce or even stop taking their steroids, with no ill effects.
Tezepelumab, also known as Tezspire and made by AstraZeneca, binds to and blocks a protein associated with airway inflammation.
The National Institute for Health and Care Excellence approved the drug in 2023 as an additional maintenance treatment for patients over 12 whose usual medication does not control their asthma well.
The Wayfinder trial, led by King’s College London, involved just under 300 adults with severe, uncontrolled asthma, who were taking 5mg-40mg of steroid tablets daily.
The patients, from 11 countries including the UK, US, France, Germany, Mexico and Spain, were given tezepelumab every month.
After one year of treatment, more than half of the participants had stopped taking their steroid medication altogether without their asthma flaring up, while nearly 90% had reduced their steroid use to a low dose. A third had stopped taking steroids after six months.
Symptoms of asthma include coughing, wheezing, breathlessness and chest tightness. Up to 10% of asthmatics have severe disease and, in the most extreme cases, it can be fatal.
The trial findings, published in The Lancet Respiratory Medicine and presented at the British Thoracic Society winter meeting, also showed that tezepelumab significantly improved asthma symptoms, lung function and overall quality of life.
During the study, two-thirds of patients did not have any asthma attacks.
The lead author of the study, Professor David Jackson, a respiratory medicine expert at King’s College London and asthma services clinical lead at Guy’s and Royal Brompton hospitals, said: “As tezepelumab also suppresses allergy-related symptoms and improves chronic rhinosinusitis as well, the results are particularly exciting for patients with severe asthma who suffer with both upper and lower airway symptoms.”
Responding to the findings, Dr Samantha Walker, the director of research and innovation at Asthma + Lung UK, said: “This is an incredibly encouraging development for the future of asthma care that could transform the lives of people with severe asthma.
“It’s vital that research into new types of treatment continues, but we know current funding for lung health research is on life support, despite lung conditions remaining the third biggest cause of death in the UK. Studies like this show the positive impact that research can make on providing potentially life-changing treatment for people with asthma and other lung conditions.”
Prof Kamila Hawthorne, the chair of the Royal College of GPs, said: “Any new interventions that may help patients manage their symptoms more easily and in a safe and effective way would be welcome.
“The prospect of a monthly injection, rather than daily tablets, may also be a more manageable treatment option for some patients.”
Study details
Oral corticosteroid reduction and discontinuation in adults with corticosteroid-dependent, severe, uncontrolled asthma treated with tezepelumab (WAYFINDER): a multicentre, single-arm, phase 3b trial
David Jackson, Njira Lugogo, Mark Gurnell et al.
Published in The Lancet Respiratory Medicine on 26 November 2026
Summary
Background
The SOURCE phase 3 oral corticosteroid (OCS)-sparing study of tezepelumab indicated an OCS-sparing effect with tezepelumab versus placebo in patients with OCS-dependent asthma and baseline blood eosinophil counts (BECs) of at least 150 cells per μL. The WAYFINDER study aimed to further evaluate the ability of tezepelumab to reduce or discontinue OCS use in a larger cohort of patients with OCS-dependent severe, uncontrolled asthma.
Method
WAYFINDER was a phase 3b, multicentre, single-arm, open-label, OCS-sparing study. Adults (aged 18–80 years) with severe, uncontrolled asthma receiving a maintenance OCS dose of 5–40 mg per day (or equivalent) of prednisone or prednisolone were recruited from 68 clinical centres across 11 countries (Argentina, Belgium, Bulgaria, France, Germany, Latvia, Mexico, Poland, Spain, UK, and USA). Participants received tezepelumab 210 mg subcutaneously once every 4 weeks for up to 52 weeks. The co-primary endpoints, assessed at weeks 28 and 52, were the proportion of participants who reduced their prescribed maintenance OCS dose to 5 mg per day or less without loss of asthma control and the proportion of participants who discontinued OCS without loss of asthma control. OCS dose reductions to below 5 mg per day were contingent on participants demonstrating preserved adrenal function.
Findings
WAYFINDER was conducted between May 17, 2022, and Sept 9, 2024. Overall, 382 participants were enrolled and 298 participants (206 female [69·1%]) received tezepelumab and were included in the efficacy and safety analyses. The mean baseline maintenance OCS dose was 10·8 (SD 6·5) mg per day. The proportion of participants who had a maintenance OCS dose of 5 mg per day or less without loss of asthma control was 265 of 298 (88·9% [95% CI 84·8–92·3]) at week 28 and 268 of 298 (89·9% [85·9–93·1]) at week 52. The proportion of participants who discontinued OCS without loss of asthma control was 96 of 298 (32·2% [26·9–37·8]) at week 28 and 150 of 298 (50·3% [44·5–56·2]) at week 52. OCS reduction and discontinuation were achieved across pre-specified subgroups based on baseline BEC, fractional exhaled nitric oxide level, or allergy status. Serious adverse events were reported in 28 (9·4%) of 298 participants (asthma [13 participants] and pneumonia [three participants] were the most common), and four participants (1·3%) had adverse events leading to tezepelumab discontinuation. Two participants died during the study but neither death was considered to be causally related to tezepelumab treatment.
Interpretation
After 52 weeks of open-label tezepelumab treatment, nearly 90% of patients with OCS-dependent severe, uncontrolled asthma had a maintenance OCS dose of 5 mg per day or less and more than 50% completely discontinued OCS, while maintaining asthma control. These findings indicate that tezepelumab treatment can help enable patients with severe asthma to reduce their OCS use and its associated burden, with broad applicability across patient phenotypes.
See more from MedicalBrief archives:
A third of patients with severe asthma taking harmful doses of oral steroids
Inhaled steroids promote secretions which block treatment in severe asthma patients – US study
More young Brits dying from asthma than anywhere in Europe
Many asthma patients exposed to high oral corticosteroids doses