Oral corticosteroid stewardship: key insights from the Australasian Severe Asthma Registry

John Politis; Li Ping Chung; Ezinne Igwe; Philip Bardin; Peter G Gibson

doi:10.1111/imj.16392

Oral corticosteroid stewardship: key insights from the Australasian Severe Asthma Registry

Intern Med J. 2024 Apr 15. doi: 10.1111/imj.16392. Online ahead of print.

Authors

John Politis^#¹, Li Ping Chung^#², Ezinne Igwe³, Philip Bardin^{1

4}, Peter G Gibson^{5

6}

Affiliations

¹ Monash Lung Sleep Allergy and Immunology, Monash University and Medical Centre, Melbourne, Victoria, Australia.
² Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
³ Thoracic Society of Australia and New Zealand, Chatswood, New South Wales, Australia.
⁴ Hudson Institute, Monash University, Melbourne, Victoria, Australia.
⁵ College of Health Medicine and Wellbeing, The University of Newcastle, New Lambton Heights, New South Wales, Australia.
⁶ Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.

^# Contributed equally.

PMID: 38622806
DOI: 10.1111/imj.16392

Abstract

Background: People with severe asthma remain at risk of toxicity from maintenance oral corticosteroid (OCS) use and/or frequent OCS burst therapy. Cumulative exposures above 500-1000 mg prednisolone are associated with adverse effects, and recently OCS stewardship principles were promulgated to guide OCS prescription.

Aims: To examine real-world registry data to quantify OCS burden, ascertain trends over time in prescription and assess whether opportunities to implement steroid-sparing strategies were utilised.

Methods: Participants were enrolled in the Australasian Severe Asthma Registry for the period 2013-2021. Assessments were taken at enrolment and then annual follow-up, which included asthma control and OCS use. Descriptive analyses were performed, and subgroups were compared at baseline and over time.

Results: Nine hundred and twenty-four participants were evaluated and 215/924 (23%) were taking maintenance OCS at baseline, with 44% and 32% of participants having exposure to ≥500 or 1000 mg of OCS respectively in the prior year. Twelve months later, an additional 10% and 9% of participants reached cumulative doses of 500 or 1000 mg. People exceeding thresholds had ongoing poor asthma control. At baseline, 240/924 (26%) people were treated with asthma biological therapy. An additional 83 (12%) participants were identified as potentially benefiting from this steroid-sparing medication. Of these patients, only 23% commenced a biologic agent in the next 12 months.

Conclusions: A large national asthma registry identifies exposure to toxic cumulative doses of OCS in more than a third of participants, with further subsequent cumulative dose escalation over 2 years. Steroid-sparing strategies were often not employed, highlighting the need for implementation of OCS stewardship initiatives.

Keywords: asthma; asthma biologics; asthma registry; oral corticosteroid stewardship; severe asthma.