High systemic corticosteroids burden among patients with moderate-to-severe asthma in the United States

Systemic corticosteroids (SCS) effectively control acute asthma exacerbations. However, repeated use of SCS causes significant adverse effects, necessitating escalation to steroid-sparing biologics.

To assess SCS utilization patterns in patients with moderate-to-severe asthma in real-world settings.

Patients with asthma initiating biologics between January 1, 2023, and December 31, 2024, were identified from the Komodo Health database. The index date was defined as the date of the first biologic claim. Patients (≥12 years) with 1 or more asthma diagnosis claims within 90 days preindex or at index and no biologic claim in the 12-month preindex period were included. Patients with other indications requiring SCS during the 12-month preindex period were excluded. The SCS utilization patterns were assessed within the 12-month preindex period. The utilization of SCS was also assessed in patients with uncontrolled moderate-to-severe asthma but who had not initiated biologics.

Overall, 30,652 patients initiated biologics. During the 12-month preindex period, 63.9% (mean: 5.0 fills) of patients received at least 2 SCS prescriptions, with 36.3% receiving 2 to 4 and 27.6% (mean: 7.7 fills) receiving 5 or more prescriptions. The mean (SD) cumulative SCS dosage was 1100.4 (862.3) mg and 1709.0 (933.6) mg, respectively; the corresponding SCS days covered were 38.3 (30.3) and 58.9 (32.8) days in patients with 2 or more and 5 or more prescriptions, respectively. Consistent SCS utilization patterns were observed in patients who had not initiated biologics.

This analysis reveals that a substantial proportion of patients with moderate-to-severe asthma receive frequent SCS prescriptions, necessitating continued education on guideline-recommended steroid-sparing strategies to achieve asthma control without SCS bursts.