Tezepelumab sustains EoE remission through 52 weeks

Adolescents and adults with eosinophilic esophagitis (EoE) that remained uncontrolled despite background therapy achieved high rates of histologic remission, plus smaller but significant dysphagia gains, with tezepelumab (Tezspire; AstraZeneca/Amgen), according to full 52-week results from the phase 3 CROSSING trial presented as a late-breaking abstract at United European Gastroenterology Week 2026 in Barcelona, Spain.¹

At week 24, 64.8% of patients receiving tezepelumab 210 mg and 68.9% receiving 420 mg every 4 weeks reached histologic remission vs 3.5% receiving placebo (P < .001 for both).¹ The effect held at week 52, with remission rates of 67.8% and 63.3%, respectively, vs 5.4% with placebo.¹

Arjan Bredenoord, MD, gastroenterologist and professor at Amsterdam University Medical Center in the Netherlands and international coordinating investigator for CROSSING, said the benefits held "even in patients who were allowed to remain on their stable background therapy."¹

CROSSING trial design and tezepelumab efficacy in EoE

CROSSING was a randomized, double-blind, placebo-controlled, multicenter trial that enrolled 368 patients aged 12 to 80 years with symptomatic, histologically active EoE.³ Participants were randomly assigned 1:1:1 to subcutaneous tezepelumab 210 mg, 420 mg, or placebo every 4 weeks and could continue stable proton pump inhibitors (PPIs) or swallowed topical corticosteroids.¹ Co-primary end points at week 24 were histologic remission, defined as a peak count of 6 or fewer eosinophils per high-power field (eos/hpf), and change from baseline in the Dysphagia Symptom Questionnaire (DSQ), a 0- to 84-point patient-reported diary score.¹

Symptom findings were less pronounced than histologic findings. At week 24, DSQ scores fell 18.8 points with 210 mg and 22.0 points with 420 mg vs 14.7 points with placebo.¹ The 210-mg difference narrowly reached significance (−4.1; 95% CI, −8.1 to −0.0; P = .049), whereas the 420-mg difference was −7.3 (95% CI, −11.3 to −3.3; P < .001).¹ Separation widened by week 52, with placebo-adjusted reductions of 8.9 and 10.8 points, respectively (P < .001 for both).¹

Endoscopic outcomes also improved. Eosinophilic Esophagitis Endoscopic Reference Score (EREFS) decreased 3.1 to 3.4 points more than placebo at weeks 24 and 52, and 34.4% (210 mg) and 29.5% (420 mg) of patients reached total endoscopic remission (EREFS of 0) at week 52 vs 4.1% with placebo (P < .001).¹

Safety was consistent with tezepelumab's approved indications, with nasopharyngitis, headache, and diarrhea the most frequently reported adverse events; event rates were not disclosed.¹

EoE burden and treatment gaps in adolescents and adults

EoE is a chronic immune-mediated esophageal disease diagnosed by symptoms of esophageal dysfunction plus an eosinophil-predominant infiltrate, typically 15 or more eos/hpf, and its incidence and prevalence are rising rapidly.⁴ The American College of Gastroenterology guideline recommends PPIs, swallowed topical steroids, empiric elimination diets, a biologic, and esophageal dilation, with feeding therapy used adjunctively in children with food aversion.⁴ The sponsors cite estimates that nearly half of patients do not achieve adequate control with standard approaches.¹

Evan Dellon, MD, professor of medicine at the University of North Carolina School of Medicine and US principal investigator, described EoE as one of the fastest-growing chronic gastrointestinal conditions seen in clinic, with many patients facing near-daily risk of food impaction.¹

TSLP inhibition and tezepelumab's current indications

Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin (TSLP), an epithelial cytokine upstream of multiple inflammatory pathways.¹ In the US, it is approved as add-on maintenance treatment for patients aged 12 years and older with severe asthma or inadequately controlled chronic rhinosinusitis with nasal polyps.² The FDA granted it orphan drug designation for EoE in 2021.¹

References

1. AstraZeneca. TEZSPIRE positive results from Phase III CROSSING trial in eosinophilic esophagitis including symptom improvement, histologic and endoscopic remission presented at United European Gastroenterology Week. News release. Business Wire. October 20, 2026. Accessed October 20, 2026. https://www.businesswire.com/news/home/20261020103666/en/

2. Amgen. TEZSPIRE delivered histologic remission and symptom improvement in eosinophilic esophagitis. News release. PR Newswire. October 20, 2026. Accessed October 20, 2026. https://www.prnewswire.com/news-releases/tezspire-delivered-histologic-remission-and-symptom-improvement-in-eosinophilic-esophagitis-302913925.html

3. Efficacy and safety of tezepelumab in patients with eosinophilic esophagitis (CROSSING). ClinicalTrials.gov identifier: NCT05583227. Accessed October 20, 2026. https://clinicaltrials.gov/study/NCT05583227

4. Dellon ES, Muir AB, Katzka DA, et al. ACG clinical guideline: diagnosis and management of eosinophilic esophagitis. Am J Gastroenterol. 2025;120(1):31-59. doi:10.14309/ajg.0000000000003194