REVErsing Airway Remodelling With Tezepelumab

The aim of this protocol is to perform a first randomized controlled trial evaluating how Tezepelumab affects the bronchial morphology (and computed tomographic variables in general) of asthmatic patients. In parallel, the investigators also hope to reproduce clinical benefits and perform a transcriptomic study that will juxtapose changes in genetic expression with changes in bronchial morphology and inflammatory signatures. The general hypothesis is that tezepelumab treatment is capable of at least partially reversing bronchial remodelling as detected on computed-tomographic (CT) scans. The investigators also expect such reversal to occur within a unique physiological repair environment that will be reflected by transcriptomic profiles

Inclusion Criteria:Admitted to screening visit:Minimum age: 18Maximum age: 85Able to perform an inspiratory and expiratory thoracic computed tomography (CT) scan, plus a nasal CTPhysician-diagnosed asthma according to GINA criteriaDisease with clinical impact: at least 1 severe or 2 moderate exacerbations in the previous 12 months despite treatment according to the best standards of careMaximal inhaled therapy comprising high dose ICS and at least a second controller according to GINABased on results of screening visit and run-in:Post-bronchodilator forced expiratory volume in 1 second (FEV1) predicted values must be at 25-90%Asthma Control Questionnaire 6 (ACQ6) > 1.5Oral corticosteroid maintenance therapy (if used) ≤7.5 mg/dayIn stable condition for the 4-week run-in periodOn CT scan, the average percentage wall area index at the B1 and B8 bronchi (generation 3) is >65%Exclusion Criteria:CT abnormalities evocative of any respiratory condition other than asthmaTreatment regimen discordant with best practicesPulmonary disease other than asthma requiring treatment during the previous 12 monthsA smoking history of >20 pack yearsReceipt of any marketed or investigational biologic agent§ within 3 months or 5 halflives (whichever is longer) prior to randomization or receipt of any investigational non biologic agent within 30 days or 5 half-lives (whichever is longest) prior to randomization or receipt of live attenuated vaccines 30 days prior to the date of randomization. Participants enrolled in current or previous tezepelumab studies will not be included. Participants on previous biologics treatment are allowed to enter the study provided the appropriate washout period is fulfilled.Absence of signed consentNon-beneficiary of the French social security, single-payer health insurance systemPresence of any condition (physical, psychological or other) that might, in the investigator's opinion, hinder study performanceThe patient is unavailable or unwilling to participate in future visitsPotential interference from other studiesProtected populations according to the French public health codeMale or female patients seeking to conceive a childWomen of childbearing potential and fertile men not using birth control methodPregnant, breastfeeding or lactating womenHistory of a clinically significant infection, including upper (URTI) or lower respiratory tract infection (LRTI), requiring treatment with antibiotics or antiviral medications finalised < 2 weeks before randomization. Patients with preexisting serious infections should be treated before initiating therapy with tezepelumab.A helminth parasitic infection diagnosed within 6 months prior to Visit 1 that has not been treated with, or has failed to respond to, standard of care therapy.Patients using vaping products, including electronic cigarettes (because may induce abnormality at CT scan).Bronchial thermoplasty in the last 12 months prior to Visit 1. History of documented immune complex disease (Type III hypersensitivity reactions) following any biologic therapy.History of known immunodeficiency disorder including a positive human immunodeficiency virus test or the participant taking antiretroviral medications as determined by medical history and/or participant's verbal report.Receipt of the T2 cytokine inhibitor Suplatast tosilate within 15 days prior to randomization.Treatment with systemic immunosuppressive/immunomodulating drugs (eg, methotrexate, cyclosporine, etc.), except for OCS used in the treatment of asthma/asthma exacerbations, within the last 12 weeks or 5 half-lives (whichever is longer) prior to randomization.Receipt of immunoglobulin or blood products within 30 days prior to randomization.Receipt of allergen immunotherapy not stable within 30 days prior to randomization or with anticipated change during the treatment period.