Related Experiment Videos
Influence of newly initiated biologic therapy on the dose of ICS therapy - Data from the German Asthma Net
Slagjana Stoshikj1, Andreas Renner1, Christina Bal1
1Clinic of Internal Medicine II - Department of Pneumology, Medical University of Vienna - Vienna, Austria; Comprehensive Center for Chest Diseases, Medical University of Vienna - Vienna, Austria.
Background:
Real-world data on inhaled corticosteroid (ICS) reduction after biologic initiation in severe asthma are limited.
Objectives:
We assessed high dose (HD)-ICS reduction and its association with asthma control, exacerbations, lung function, and fractional exhaled nitric oxide (FeNO).
Methods:
Adults in the German Asthma Net registry initiating benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, or tezepelumab with documented ICS use and 4-month, 1-, or 2-year follow-up were analyzed. ICS doses were converted to beclomethasone dipropionate equivalents (BDE) per GINA and reducers were defined by HD-ICS step-down to medium/low-dose ICS during follow-up and compared to non-reducers. Remission was defined as an Asthma Control Test (ACT) ≥20, no exacerbations, and no oral corticosteroids after 1 year of biologics. Analyses used adjusted linear, log-linear, and Poisson regression models (standard or mixed-effects, as appropriate), along with Kendall's τ and Spearman's rank correlation coefficients.
Results:
Among 1,181 patients (1,372 visits; 55 ± 13 years; 57% female), HD-ICS use declined from 90.7% to 79.9% over 2 years. Median BDEs dose decreased from 1600 to 1000 μg (n=287; P=.004). ICS-Reduction was observed in patients with greater improvements in ACT, ACQ-5 and mAQLQ than in patients not reducing (all P<.05) without worsening exacerbations over 2 years. Reduction after 4 months was associated with better FEV1 improvement (all P=.03) but not thereafter; other lung function measures improved comparably, except for greater FRC reduction among reducers at year 2 (P=.02). FeNO decreased overall, with a smaller 1-year reduction among reducers (P = .050). Remission was associated with higher ICS reduction rates (year 1: 23.0% vs. 8.7 %, P=.0001; year 2: 26.3% vs. 10.8%, P=.004). Correlation analyses largely confirmed the main findings.
Conclusion:
ICS reduction was associated with improved patient-reported outcomes without worsening exacerbations, lung function or FeNO.
Related Concept Videos
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:19Antiasthma Drugs: Leukotriene Modifiers
Leukotriene modifiers work through two distinct mechanisms:
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce relaxation in these...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:29Therapeutic Drug Monitoring: Affecting Factors