Prevalence and recovery of adrenal insufficiency in steroid-dependent asthma patients receiving biologic therapy

Nanzer, AM; Chowdhury, Aqib B.; Raheem, Asma; Roxas, C; Fernandes, Mariana; Thomson, Louise; Green, Linda; Dhariwal, Jaideep; d’Ancona, G; Kent, Brian D.; Kelly, P; Jackson, David J.

doi:10.1183/13993003.02273-2019

Cited by 10 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2,8,9 Importantly, exposure to exogenous corticosteroids can also cause suppression of the hypothalamic-pituitary-adrenal axis, putting the patient at risk of adrenal insufficiency, a common but seldom-assessed sequela of oral corticosteroid use. 10,11 The associated diminished stress response can lead to inadequate defence against intercurrent illness such as infection. 12 The equivalent of two to four courses (0•5-1 grams) of oral corticosteroids can cause serious adverse events, 13 including adrenal insufficiency, and the risks increase with longer-term therapy, more frequent courses, and higher cumulative dosages.…”

Section: Introductionmentioning

confidence: 99%

Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study

Menzies‐Gow

Gurnell

Heaney

et al. 2022

The Lancet Respiratory Medicine

104

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study

Menzies‐Gow

Gurnell

Heaney

et al. 2022

The Lancet Respiratory Medicine

104

View full text Add to dashboard Cite

“…Effective mOCS reduction and withdrawal reveals underlying adrenal insufficiency in patients treated with anti-IL-5 mAbs in around 75% of cases [ 97 ]. It is, therefore, important to monitor early-morning cortisol as OCS is weaned towards physiological levels.…”

Section: Additional Considerationsmentioning

confidence: 99%

A pragmatic guide to choosing biologic therapies in severe asthma

Kavanagh

Hearn

Jackson

2021

Breathe

Self Cite

View full text Add to dashboard Cite

There are now several monoclonal antibody (mAb) therapies (“biologics”) available to treat severe asthma. Omalizumab is an anti-IgE mAb and is licensed in severe allergic asthma. Current evidence suggests it may decrease exacerbations by augmenting deficient antiviral immune responses in asthma. Like all other biologics, clinical efficacy is greatest in those with elevated T2 biomarkers. Three biologics target the interleukin (IL)-5–eosinophil pathway, including mepolizumab and reslizumab that target IL-5 itself, and benralizumab that targets the IL-5 receptor (IL-5R-α). These drugs all reduce the exacerbation rate in those with raised blood eosinophil counts. Mepolizumab and benralizumab have also demonstrated steroid-sparing efficacy. Reslizumab is the only biologic that is given intravenously rather than by the subcutaneous route. Dupilumab targets the IL-4 receptor and like mepolizumab and benralizumab is effective at reducing exacerbation rate as well as oral corticosteroid requirements. It is also effective for the treatment of nasal polyposis and atopic dermatitis. Tezepelumab is an anti-TSLP (thymic stromal lymphopoietin) mAb that has recently completed phase 3 trials demonstrating significant reductions in exacerbation rate even at lower T2 biomarker thresholds.Many patients with severe asthma qualify for more than one biologic. To date, there are no head-to-head trials to aid physicians in this choice. However, post-hoc analyses have identified certain clinical characteristics that are associated with superior responses to some therapies. The presence of allergic and/or eosinophilic comorbidities, such as atopic dermatitis, nasal polyposis or eosinophilic granulomatosis with polyangiitis, that may additionally benefit by the choice of biologic should also be taken into consideration, as should patient preferences which may include dosing frequency. To date, all biologics have been shown to have excellent safety profiles.

show abstract

“…[29,30] Another possible explanation for the residual OCS exposure is adrenal insufficiency which is a major side effect of long-term OCS use. [31] Adrenal insufficiency was not systematically assessed in the study population, which has likely led to an underreporting of adrenal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Cumulative corticosteroid-sparing effect of anti-interleukin-5/5Ra in eosinophilic asthma

et al. 2022

View full text Add to dashboard Cite

IntroductionAnti-interleukin-5/5Ra therapy has shown to reduce maintenance oral corticosteroid dose in severe eosinophilic asthma. However, the effect on cumulative oral corticosteroid exposure is currently unknown. Neither is it known how prior oral corticosteroid exposure affects response to anti-interleukin-5/5Ra treatment. We aimed primarily to compare the cumulative oral corticosteroid exposure over a 2-year period before and after anti-interleukin-5/5Ra initiation, and secondarily to investigate whether duration and cumulative oral corticosteroid exposure prior to anti-interleukin-5/5Ra influence the ability to discontinue oral corticosteroids within 2 years of anti-interleukin-5/5Ra therapy.MethodsThis real-world nationwide observational registry-based study evaluated all dispensed oral corticosteroids from 389 adults with severe eosinophilic asthma included in the Dutch severe asthma registry (RAPSODI) 2 years before and 2 years after initiating anti- interleukin-5/5Ra. Wilcoxon-signed rank test and multivariable regression analyses were used.ResultsMedian (IQR) cumulative oral corticosteroid exposure in the 2 years before and after anti-interleukin-5/5Ra initiation decreased from 2.715 g (1.150–5.539) to 1.050 g (0.300–3.640), p<0.001. Fifty-two percent of patients were able to discontinue oral corticosteroids within 2 years anti-interleukin-5/5Ra therapy, which was independently predicted by lower and shorter prior oral corticosteroid exposure.ConclusionThis real-world study showed that anti-interleukin-5/5Ra therapy leads to a significant reduction in cumulative oral corticosteroid exposure over a 2-year period. Patients with lower and shorter oral corticosteroids exposure were more likely to completely eliminate oral corticosteroids. Since cumulative exposure increased progressively prior to anti-interleukin-5/5Ra initiation, our data suggest that early intervention leads to a better long-term prognosis in patients with severe eosinophilic asthma.

show abstract

Prevalence and recovery of adrenal insufficiency in steroid-dependent asthma patients receiving biologic therapy

Cited by 10 publications

References 12 publications

Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study

Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study

A pragmatic guide to choosing biologic therapies in severe asthma

Cumulative corticosteroid-sparing effect of anti-interleukin-5/5Ra in eosinophilic asthma

Contact Info

Product

Resources

About