Phenotype and biomarkers in patients who initiated biologics therapy stratified by oral corticosteroid use in the International Severe Asthma Registry

Background: Oral corticosteroids (OCS) are overused in severe asthma patients, but the profile of patients who use OCS is not sufficiently described.

Aims: To compare the phenotype and biomarkers of severe asthma patients before biologic initiation by pre-biologic OCS use.

Methods: This cross-sectional study used the International Severe Asthma Registry, a multinational prospective registry of asthma patients aged ≥18 years old on GINA step 4/5 therapy. Those with biologic initiation and ≥1 year of prior data were included and grouped by OCS use (non-users, intermittent users, and long-term [LTOCS] users).

Results: In total, 4,305 patients were included (41% LTOCS users, 54% intermittent users, 5% non-users). Most patients had an eosinophilic phenotype and ≥1 type 2 comorbidity (Table). LTOCS users had the highest proportions of persistent airway obstruction and blood eosinophil count <150 cells/µL (Table). Long-term and intermittent OCS users had higher frequencies of uncontrolled asthma than non-users (Table).

Conclusions: Most severe asthma patients had LTOCS/intermittent OCS use before initiating biologics. LTOCS users had the wort lung function, with distinct biomarker patterns. Reasons for poor asthma control in OCS users and OCS’ confounding effects on biomarkers need exploration.