A case of type 2 diabetes mellitus with weight gain and worsening of glycemic management after tezepelumab administration for severe bronchial asthma

Some cases of bronchial asthma are refractory to conventional therapies. As the pathogenesis of bronchial asthma has been clarified, new treatments, such as bronchial thermoplasty and biological drugs, have been developed. Tezepelumab, an anti-thymic stromal lymphopoietin antibody, has been reported to inhibit the exacerbation of severe asthma; however, its adverse effects on glucose metabolism have not yet been reported. We encountered a case of weight gain and worsening glycemic management in a patient with type 2 diabetes and refractory bronchial asthma after the initiation of tezepelumab treatment. It has been reported that the overexpression of thymic stromal lymphopoietin in mice resulted in an enhanced release of free fatty acids from adipose tissues and the liver; thus, the administration of anti-thymic stromal lymphopoietin antibodies in the present case might have caused obesity, fatty liver and lower glucose tolerance. Patients with type 2 diabetes mellitus complicated by refractory severe asthma were treated with tezepelumab, an anti-thymic stromal lymphopoietin antibody. The requirement of prednisolone due to asthma exacerbation was decreased, but the patient showed worsening of glycemic management, increased insulin requirement and weight gain. When administering tezepelumab to patients with asthma complicating type 2 diabetes, careful follow up regarding glycemic management and weight might be necessary.image