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Background <p>In severe asthma, intensive (“<i>supratherapeutic</i>”) doses of inhaled corticosteroids (ICS) are often used. The prevalence of supratherapeutic ICS use and its impact on corticosteroid-related comorbidities is poorly understood. We aimed to describe the prevalence of supratherapeutic ICS use in severe asthma, its relation to corticosteroid-related comorbidities, and changes in prescribed and redeemed ICS dose after 12 months of biologic therapy.</p> Methods <p>Patients from the nationwide Danish Severe Asthma Register (DSAR) receiving biologic therapy &gt; 12 months were included. Supratherapeutic doses were defined as &gt; 1600 µg <i>budesonide</i> daily. Baseline characteristics, comorbidity burden, and change in ICS use after 12 months of biologic therapy was stratified according to ICS use at baseline.</p> Results <p>We included 652 patients in our analyses and 156 (24%) were supratherapeutic ICS users prior to initiation of biologic therapy. Supratherapeutic ICS users had a higher baseline prevalence of cataracts at 14 <i>vs</i> 8.1%; <i>p</i> = 0.025. No differences in other corticosteroid-related comorbidities were observed.</p> <p>No change in prevalence of prescribed supratherapeutic ICS was seen after 12 months of biologic therapy. However, a reduction in ICS adherence among supratherapeutic users was observed with 72% of patients demonstrating &gt; 80% adherence at 12 months, compared to 83% at baseline (<i>p</i> &lt; 0.001).</p> Conclusion <p>Supratherapeutic doses of ICS were used by almost one-fourth of the patients prior to initiation of biologic therapy and were associated with a higher prevalence of cataracts. Physician-driven ICS reduction was rare, yet supratherapeutic ICS users were found to self-regulate ICS therapy when treated with biologic therapy.</p>

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Supratherapeutic Inhaled Corticosteroid Use in Patients Initiating on Biologic Therapies for Severe Asthma: A Nationwide Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月11日

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  • Frederikke Hjortdahl,
  • Marianne Baastrup Soendergaard,
  • Susanne Hansen,
  • Anne-Sofie Bjerrum,
  • Anna von Bülow,
  • Ole Hilberg,
  • Barbara Bonnesen,
  • Claus Rikard Johnsen,
  • Sofie Lock Johansson,
  • Linda Makowska Rasmussen,
  • Johannes Martin Schmid,
  • Charlotte Suppli Ulrik,
  • Anne Byriel Walls,
  • Celeste Porsbjerg,
  • Kjell Erik Julius Håkansson

摘要

Background

In severe asthma, intensive (“supratherapeutic”) doses of inhaled corticosteroids (ICS) are often used. The prevalence of supratherapeutic ICS use and its impact on corticosteroid-related comorbidities is poorly understood. We aimed to describe the prevalence of supratherapeutic ICS use in severe asthma, its relation to corticosteroid-related comorbidities, and changes in prescribed and redeemed ICS dose after 12 months of biologic therapy.

Methods

Patients from the nationwide Danish Severe Asthma Register (DSAR) receiving biologic therapy > 12 months were included. Supratherapeutic doses were defined as > 1600 µg budesonide daily. Baseline characteristics, comorbidity burden, and change in ICS use after 12 months of biologic therapy was stratified according to ICS use at baseline.

Results

We included 652 patients in our analyses and 156 (24%) were supratherapeutic ICS users prior to initiation of biologic therapy. Supratherapeutic ICS users had a higher baseline prevalence of cataracts at 14 vs 8.1%; p = 0.025. No differences in other corticosteroid-related comorbidities were observed.

No change in prevalence of prescribed supratherapeutic ICS was seen after 12 months of biologic therapy. However, a reduction in ICS adherence among supratherapeutic users was observed with 72% of patients demonstrating > 80% adherence at 12 months, compared to 83% at baseline (p < 0.001).

Conclusion

Supratherapeutic doses of ICS were used by almost one-fourth of the patients prior to initiation of biologic therapy and were associated with a higher prevalence of cataracts. Physician-driven ICS reduction was rare, yet supratherapeutic ICS users were found to self-regulate ICS therapy when treated with biologic therapy.