前言
有患者发现,部分医院和药店已经能开到特泽利尤单抗了。作为目前唯一作用于炎症级联反应最上游(TSLP)的生物制剂,它到底值不值得打?
价格
泰适卓(特泽利尤单抗注射液)上海挂网价为 9500 元/盒(210mg×1 支)。
推荐剂量为每 4 周皮下注射 1 次 210mg,算下来一年治疗费用约 12.35 万元。
该药目前尚未纳入国家医保目录。对多数家庭来说,这个数字确实需要认真掂量。
一、特泽利尤单抗靶点作用机制
特泽利尤单抗靶向胸腺基质淋巴细胞生成素(TSLP),能够直接作用于炎症通路顶端,抑制多种与气道炎症相关的生物标志物和细胞因子的表达,并且不受表型及生物标志物水平限制。
传统生物制剂大多需要先检测嗜酸性粒细胞等指标才能判断是否适用,而特泽利尤单抗无需这一前置步骤。这对那些炎症驱动因素不明确、或不符合现有生物制剂条件的患者来说,治疗路径确实不一样了。
机制定位:炎症级联反应的最上游
IL-4Rα、IL-5、IL-5R、IgE 等靶点分别针对特定下游炎症通路,而 TSLP 作用于炎症级联反应的顶端。通过靶向 TSLP 这一关键的上皮"预警素",特泽利尤单抗能够实现对慢性鼻窦炎伴鼻息肉症状的快速改善,并几乎消除患者的手术需求。
也正因如此,《全球支气管哮喘防治创议(2025)》(GINA 2025)在内的国内外指南共识均指出:无论炎症表型如何,均可考虑使用抗 TSLP 单抗治疗重度哮喘。
二、关键临床研究数据
(一)重度哮喘:DIRECTION Ⅲ 期研究
DIRECTION Ⅲ 期临床研究于中国、韩国及菲律宾开展,入组患者中 77% 来自中国。研究结果表明,与安慰剂相比,使用特泽利尤单抗治疗 52 周,亚洲患者总体人群的哮喘年急性发作率(AAER)降低 74%,具有显著统计学意义和临床意义;其中特泽利尤单抗治疗组与安慰剂组的年急性发作率分别为 0.42 和 1.63。
74%
亚洲患者 AAER 降幅
95% CI 61–83;p<0.001
0.42 vs 1.63
年急性发作率(治疗组 vs 安慰剂)
80%
中国患者亚组 AAER 降幅
在中国患者亚组中,与安慰剂相比哮喘年急性发作率降低 80%。
同时,特泽利尤单抗达到研究的所有关键次要终点,较基线改善患者肺功能、哮喘症状和生活质量,且安全性及耐受性良好。
(二)慢性鼻窦炎伴鼻息肉:WAYPOINT Ⅲ 期研究
在 WAYPOINT Ⅲ 期临床研究中,特泽利尤单抗降低了通过共同主要终点评估的鼻息肉严重程度,结果具有显著统计学及临床意义:治疗第 52 周时,鼻息肉评分(NPS)降低 2.08 分,患者自我报告鼻塞症状评分(NCS)降低 1.04 分。
2.08
鼻息肉评分 NPS 降低(分)
p<0.0001
1.04
鼻塞评分 NCS 降低(分)
p<0.0001
98%
鼻息肉手术需求降幅
p<0.0001
鼻息肉评分(NPS)的改善最早见于第 4 周,患者自评鼻塞症状评分(NCS)的改善最早见于第 2 周,且疗效持续至第 52 周。尤为重要的是,与安慰剂组相比,特泽利尤单抗几乎完全消除患者后续鼻息肉手术需求,降幅达 98%(p<0.0001),并显著减少患者系统性糖皮质激素使用需求,降幅达 89%(p<0.0001)。
安全性
在 DIRECTION 和 WAYPOINT 研究中,特泽利尤单抗的安全性和耐受性与其已知特性基本一致,未提示新的安全性信号。
三、横向对比:已上市靶向药物
两类药物的靶点不同,医保状态差异显著。已有多款同类靶向药获批,其中司普奇拜单抗、奥马珠单抗等已进医保,特泽利尤单抗目前为自费。
慢性鼻窦炎伴鼻息肉(CRSwNP)领域
哮喘领域
怎么看这笔账
从靶点看,特泽利尤单抗作用于炎症级联最上游、无需前置生物标志物检测,覆盖人群更广;但从花费看,其年费用约 12.35 万元且自费,远高于已进医保的同类药。
是否"值得",取决于病情严重程度、既往治疗反应,以及对自费支出的承受力——建议与主治医生结合个体情况评估。
五、临床用药:新药正在招募
对于鼻息肉与哮喘患者,目前已有作用机制相似的在研新药开展临床用药招募。若既往使用现有药物治疗效果不佳,或家庭经济状况难以承担长期自费治疗,可以考虑关注临床研究提供的用药机会。
这类研究通常能在使用规范药物之外,提供规范化随访与新药使用通道,对控制不佳且经济压力大的人群尤其值得了解。
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