Hjortdahl Frederikke, Soendergaard Marianne Baastrup, Hansen Susanne, Bjerrum Anne-Sofie, von Bülow Anna, Hilberg Ole, Bonnesen Barbara, Johnsen Claus Rikard, Johansson Sofie Lock, Rasmussen Linda Makowska, Schmid Johannes Martin, Ulrik Charlotte Suppli, Walls Anne Byriel, Porsbjerg Celeste, Håkansson Kjell Erik Julius
Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
Centre for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark.
Lung. 2025 Mar 11;203(1):42. doi: 10.1007/s00408-025-00796-5.
In severe asthma, intensive ("supratherapeutic") doses of inhaled corticosteroids (ICS) are often used. The prevalence of supratherapeutic ICS use and its impact on corticosteroid-related comorbidities is poorly understood. We aimed to describe the prevalence of supratherapeutic ICS use in severe asthma, its relation to corticosteroid-related comorbidities, and changes in prescribed and redeemed ICS dose after 12 months of biologic therapy.
Patients from the nationwide Danish Severe Asthma Register (DSAR) receiving biologic therapy > 12 months were included. Supratherapeutic doses were defined as > 1600 µg budesonide daily. Baseline characteristics, comorbidity burden, and change in ICS use after 12 months of biologic therapy was stratified according to ICS use at baseline.
We included 652 patients in our analyses and 156 (24%) were supratherapeutic ICS users prior to initiation of biologic therapy. Supratherapeutic ICS users had a higher baseline prevalence of cataracts at 14 vs 8.1%; p = 0.025. No differences in other corticosteroid-related comorbidities were observed. No change in prevalence of prescribed supratherapeutic ICS was seen after 12 months of biologic therapy. However, a reduction in ICS adherence among supratherapeutic users was observed with 72% of patients demonstrating > 80% adherence at 12 months, compared to 83% at baseline (p < 0.001).
Supratherapeutic doses of ICS were used by almost one-fourth of the patients prior to initiation of biologic therapy and were associated with a higher prevalence of cataracts. Physician-driven ICS reduction was rare, yet supratherapeutic ICS users were found to self-regulate ICS therapy when treated with biologic therapy.
在重度哮喘中，常使用大剂量（“超治疗剂量”）吸入性糖皮质激素（ICS）。超治疗剂量ICS的使用 prevalence 及其对糖皮质激素相关合并症的影响尚不清楚。我们旨在描述重度哮喘中超治疗剂量ICS的使用 prevalence、其与糖皮质激素相关合并症的关系以及生物治疗12个月后规定和使用的ICS剂量变化。
纳入来自丹麦全国重度哮喘登记处（DSAR）接受生物治疗超过12个月的患者。超治疗剂量定义为每日布地奈德>1600μg。根据基线时的ICS使用情况对基线特征、合并症负担以及生物治疗12个月后ICS使用的变化进行分层。
我们纳入652例患者进行分析，156例（24%）在开始生物治疗前为超治疗剂量ICS使用者。超治疗剂量ICS使用者白内障的基线患病率较高，分别为14%和8.1%；p = 0.025。未观察到其他糖皮质激素相关合并症的差异。生物治疗12个月后，规定的超治疗剂量ICS的患病率未见变化。然而，观察到超治疗剂量使用者的ICS依从性降低，72%的患者在12个月时依从性>80%，而基线时为83%（p < 0.001）。
近四分之一的患者在开始生物治疗前使用了超治疗剂量的ICS，且与较高的白内障患病率相关。医生主导的ICS减量很少见，但发现超治疗剂量ICS使用者在接受生物治疗时会自我调整ICS治疗。
