Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

Academic Article


  • Background: Severe asthma (SA) often requires subspecialist management and treatment with biologic therapies or maintenance systemic corticosteroids (mSCS). Objective: To describe contemporary, real-world biologic and mSCS use among US subspecialist-treated patients with SA. Methods: CHRONICLE is an ongoing, noninterventional study of US adults with SA treated by allergists/immunologists or pulmonologists. Eligible patients are receiving biologics or mSCS or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers. Biologic and mSCS use patterns and patient characteristics were summarized for patients enrolled between February 2018 and February 2019. Results: Among protocol-eligible patients, 58% and 12% were receiving biologics and mSCS, respectively, with 7% receiving both. Among 796 enrolled, most were women (67%), non-Hispanic white (71%), of suburban residence (50%), and had elevated body mass index (median: 31). Respiratory and nonrespiratory comorbidities were highly prevalent. With biologics (n = 557), 51% were anti–immunoglobulin E and 48% were anti–interleukin (IL)-5/IL-5Rα; from May 2018, 76% of initiations were anti–IL-5/IL-5Rα. In patients receiving mSCS, median prednisone-equivalent daily dose was 10 mg. Multivariate logistic regression found that patients of hospital clinics, sites with fewer nonphysician staff, and with a recorded concurrent chronic obstructive pulmonary disease diagnosis were less likely to receive biologics and more likely to receive mSCS. Conclusion: In this real-world sample of US subspecialist-treated patients with SA not controlled by high-dosage inhaled corticosteroids with additional controllers, mSCS use was infrequent and biologic use was common, with similar prevalence of anti–immunoglobulin E and anti–IL-5/IL-5Rα biologics. Treatment differences associated with patient and site characteristics should be investigated to ensure equitable access to biologics and minimize mSCS use. Trial Registration: Identifier: NCT03373045.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Moore WC; Panettieri RA; Trevor J; Ledford DK; Lugogo N; Soong W; Chipps BE; Carr W; Belton L; Gandhi H
  • Start Page

  • 294
  • End Page

  • 303.e1
  • Volume

  • 125
  • Issue

  • 3