Characteristics of long-term oral corticosteroid users stratified by blood eosinophil count in the International Severe Asthma Registry

<bold>Background:</bold> Long-term oral corticosteroid (LTOCS) use is common in severe asthma (SA) Subsequent management of patients on LTOCS can be informed by endotypic features, e.g. blood eosinophil count (BEC). <bold>Aims:</bold> To characterize the phenotype and endotype of patients with SA and LTOCS use before biologics initiation, stratified by BEC. <bold>Methods:</bold> This cross-sectional study used the International Severe Asthma Registry, a multinational prospective registry of patients aged ≥18 years old with asthma on GINA step 4/5 therapy. Patients with LTOCS use and biologics initiation with ≥1 year of prior data were included, grouped by BEC (<150 vs ≥150 cells/µL). <bold>Results:</bold> In total, 1,288 patients were included (369 with BEC <150 cells/µL, 919 with BEC ≥150 cells/µL). Most had ≥1 type 2 comorbidity with elevated IgE (≥75 IU/mL) and/or FeNO (≥20 ppb; Table). More of the high-BEC group had uncontrolled/partially controlled asthma and/or persistent airway obstruction, but slightly fewer had daily OCS dose >5mg (Table). In the year before biologic initiation, the high-BEC group had more frequent asthma-related emergency department visits, but not exacerbations or hospitalizations (Table). <bold>Conclusion:</bold> Patients with SA and LTOCS use had a high steroid burden, among whom, those with high-BEC had worse asthma control and lung function. Better access to steroid-sparing therapies is needed regardless of BEC. <fig><object-id>erj;64/suppl_68/PA439/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

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Journal
Epidemiology
Published
2024-09-14
DOI
https://doi.org/10.1183/13993003.congress-2024.pa439
Primary Topic
Asthma and respiratory diseases
Type
article
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article

Characteristics of long-term oral corticosteroid users stratified by blood eosinophil count in the International Severe Asthma Registry

Lakmini Bulathsinhala, Piotr Kuna, Breda Cushen, Matthew Peters et al.
Epidemiology
Asthma and respiratory diseases
article

Characteristics of long-term oral corticosteroid users stratified by blood eosinophil count in the International Severe Asthma Registry

Lakmini Bulathsinhala, Piotr Kuna, Breda Cushen, Matthew Peters, Riyad Al‐Lehebi, Mariko Siyue Koh, Tatsuya Nagano, Mohit Bhutani, Dóra Lúðvíksdóttir, Ruth Murray, Kirsty Fletton, Florence Schleich, Michael P. Makris, Sundeep Salvi, Jorge Fernando Maspero, Eve Denton, Libardo Jiménez-Maldonado, Zsuzsanna Csoma, George Christoff, Désirée Larenas‐Linnemann, John Townend, Todor A. Popov, ARNAUD AB BOURDIN, Rebecca Gall, Christian Taube, Francesca Puggioni, Alan Altraja, Celine Goh, David Price, Charlotte Suppli Ulrik, Paul Pfeffer, Victoria Carter, Andréanne Côté, Hyonsoo Joo, Jeffrey Shi Kai Chan, Mona Al‐Ahmad, Simon Couillard, Vidya V. Navaratnam, Paulo Márcio Pitrez, Belinda Cochrane, Ming‐Ju Tsai, Luis Pérez de Llano, John Blakey, João Fonseca, Lauri Lehtimäki, Aaron Beastall, Zhixiao Wang, Bassam Mahboub, Leif Bjermer, Bernt Bøgvald Aarli, Wei‐Han Cheng
article en

Abstract

<bold>Background:</bold> Long-term oral corticosteroid (LTOCS) use is common in severe asthma (SA) Subsequent management of patients on LTOCS can be informed by endotypic features, e.g. blood eosinophil count (BEC). <bold>Aims:</bold> To characterize the phenotype and endotype of patients with SA and LTOCS use before biologics initiation, stratified by BEC. <bold>Methods:</bold> This cross-sectional study used the International Severe Asthma Registry, a multinational prospective registry of patients aged ≥18 years old with asthma on GINA step 4/5 therapy. Patients with LTOCS use and biologics initiation with ≥1 year of prior data were included, grouped by BEC (<150 vs ≥150 cells/µL). <bold>Results:</bold> In total, 1,288 patients were included (369 with BEC <150 cells/µL, 919 with BEC ≥150 cells/µL). Most had ≥1 type 2 comorbidity with elevated IgE (≥75 IU/mL) and/or FeNO (≥20 ppb; Table). More of the high-BEC group had uncontrolled/partially controlled asthma and/or persistent airway obstruction, but slightly fewer had daily OCS dose >5mg (Table). In the year before biologic initiation, the high-BEC group had more frequent asthma-related emergency department visits, but not exacerbations or hospitalizations (Table). <bold>Conclusion:</bold> Patients with SA and LTOCS use had a high steroid burden, among whom, those with high-BEC had worse asthma control and lung function. Better access to steroid-sparing therapies is needed regardless of BEC. <fig><object-id>erj;64/suppl_68/PA439/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Epidemiology
Reykjavík University (IS), Camden and Campbelltown Hospitals (AU), Dubai Health Authority (AE), Centre National de la Recherche Scientifique (FR), Concord Hospital (US), Université de Sherbrooke (CA), Kaohsiung Medical University (TW), University of Alberta (CA), Inserm (FR), University of Liège (BE), University of Iceland (IS), The University of Western Australia (AU), Université de Montpellier (FR), National and Kapodistrian University of Athens (GR), Singapore General Hospital (SG), Barts Health NHS Trust (GB), Concord Repatriation General Hospital (AU), Santa Casa Hospital (BR), Haukeland University Hospital (NO), Beaumont Hospital (IE), King Fahd Medical City (SA), Hvidovre Hospital (DK), Sir Charles Gairdner Hospital (AU), Tartu University Hospital (EE), Medical University of Sofia (BG), Kuwait University (KW), AVEO Oncology (United States) (US), Physiologie et Médecine Expérimentale du Coeur et des Muscles (FR), Ruhrlandklinik (DE), Hospital Médica Sur (MX), University Hospital St. Ivan Rilski (BG), National University Hospital of Iceland (IS), The Catholic University of Korea Uijeongbu St. Mary's Hospital (KR), Education & Research Foundation (US), St. Mary's Hospital (US), Progenics Pharmaceuticals (United States) (US), Observational & Pragmatic Research Institute (SG), Medical University of Lodz (PL), Tampere University Hospital (FI), Office of Patient Care Services (US), Tampere University (FI), Decision Sciences (United States) (US), Centre for Health Technology and Services Research (PT), Skåne University Hospital (SE), University General Hospital Attikon (GR), Hospital Universitario Lucus Augusti (ES), Favaloro Foundation (AR), Colombian Association of Surgery (CO), IRCCS Humanitas Research Hospital (IT), Alfred Health (AU), Országos Korányi Tbc és Pulmonológiai Intézet (HU), Université Laval (CA), Kobe University (JP)
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Asthma and respiratory diseases
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