(323) High Systemic Corticosteroid Burden Among Patients with Uncontrolled Moderate-to-severe Asthma in the US

Background:
Patients with uncontrolled moderate-to-severe asthma often receive multiple bursts of systemic corticosteroids (SCS) therapy despite the well-documented risk for adverse effects from even short-term use (e.g., infection, fracture).

Objective:
To describe the patterns of SCS use and corresponding patient characteristics in routine clinical practice in the US for uncontrolled moderate-to-severe asthma despite optimal adherence to inhaled corticosteroids (ICS).

Methods:
A cross-sectional study was conducted using the Komodo claims database. A healthcare encounter with asthma diagnosis in 4/1/2022 - 6/30/2023 was randomly selected and defined as the index date. Patients were required to be ≥12 years old, with ≥12 months of pre-index health plan enrollment (baseline), have no exposure to biologics during baseline, have uncontrolled asthma (i.e., ≥1 asthma related hospitalization or emergency room visit or an SCS dispensation ≤7 days after an outpatient visit with an asthma diagnosis during baseline), have moderate-to-severe asthma (≥1 dispensation of medium-to-high dose ICS/long-acting beta-agonists during baseline), be adherent to the ICS treatment (i.e., proportion of days covered ≥80%) and without other autoimmune diseases or organ transplant. During baseline, patients’ demographics, comorbidities, and SCS use including number of fills, cumulative and daily dose of SCS, and cumulative days of SCS use were summarized for short term SCS users and long term SCS users, based on whether they had ≥ 90 days of continuous SCS use during the baseline.

Results:
Among 46,454 patients with uncontrolled moderate-to-severe asthma who were adherent to their ICS treatment (median age: 57 years; female: 67.9%), 58.9% had ≥2 and 18.7% had ≥ 5 SCS fills for short-term use while 4.3% were long-term SCS users in the 1-year baseline. Among patients with ≥2 and ≥5 SCS fills, the median (Q1, Q3) cumulative prednisone equivalent SCS dose was 677.0 (400.0, 1200.0) mg and 1415.0 (982.8, 2208.8); median (Q1, Q3) daily dose was 31.8 (24.3, 41.3) and 33.3 (25.6, 44.1), and median (Q1, Q3) cumulative days covered by SCS was 20 (12, 35) and 41 (30, 62), respectively. Patients with ≥2 and patients with ≥5 SCS fills had a numerically higher proportion of females (69.7% and 71.7% vs 65.4%), more atopic comorbidities (50.0% and 52.0% vs 40.1%) than patients with <2 SCS prescriptions. Long-term SCS users had median (Q1, Q3) cumulative days covered by SCS of 276 (180, 365).

Conclusion:
Despite good ICS adherence (80%), about a quarter of biologic naive uncontrolled moderate-to-severe asthma patients either received ≥5 courses of SCS or were on long-term SCS therapy during a one-year period, which places patients at risk of SCS-related adverse effects.