Severe asthma: Oral corticosteroids maintenance therapy associated with toxicity

Pneumonia and osteopenia had the highest prevalence of adverse events after long-term oral corticosteroid use in patients with severe asthma in the ongoing, multicentre CHRONICLE study. The authors recommend systemic corticosteroid-sparing treatment strategies for severe asthma patients [1].

“Oral corticosteroids are widely used in patients with the most severe forms of asthma, but the outcome is not well understood,” said Prof. Njira Lugogo (University of Michigan, USA). There is a growing recognition of the adverse consequences of maintenance systemic corticosteroid therapy in asthma treatment [2]. However, only a few studies have assessed this effect in severe asthma patients with a specialist-confirmed diagnosis. The CHRONICLE study is an ongoing, non-interventional, observational study of adults with severe asthma. Participants receive biologic treatments and/or maintenance systemic corticosteroid therapy.

In the present analysis presented by Prof. Lugogo, the prevalence of potential systemic corticosteroid (SCS)-associated conditions was compared between patients with no reported history of maintenance therapy with SCS (SCS use for <30 days) (n=600), SCS use with a cumulative duration of <2 years (n=83), and SCS use with a cumulative duration of ≥2 years (n=113).

Of the 796 participants enrolled across 89 sites in the USA between February 2018 and February 2019, maintenance use of SCS was documented in 196 patients, 83 of them were treated for <2 years, and 113 for ≥2 years. Pneumonia and osteopenia were had the highest prevalence regarding the adverse conditions of systemic corticosteroids. The prevalence of associated adverse conditions was more pronounced in patients with SCS use ≥2 years. “We noticed a clear dose response effect,” Prof. Lugogo explained. Percentage of patients with a BMI ≥30 was 51% in the group without SCS use, 61% in the group with SCS use <2 years, and 43% in the group with SCS use of ≥2 years. “As there was no higher BMI in patients treated with systemic corticosteroids, the adverse outcome is independent of obesity,” Prof. Lugogo said.

Healthcare providers should employ SCS-sparing treatment strategies to avoid the negative consequences of this therapy. “There is a much higher risk of toxicity – we definitely need to think about this,” emphasised Prof. Lugogo.

 

1. Lugogo NL. Maintenance systemic corticosteroid use is associated with multiple adverse conditions in U.S. adults with severe asthma: Results from the Chronicle Study. P364, ATS 2020 Virtual, 5-10 Aug.


2. Price DB, et al. J Asthma Allergy 2018;11:193-204.

 

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Posted on 29 October, 202029 October, 2020