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

Abstract

ABSTRACTBackgroundPeople 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.AimsTo 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.MethodsParticipants 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.ResultsNine 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.ConclusionsA 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.