Language
English
Publication Date
10-28-2025
Journal
The Journal of Allergy and Clinical Immunology: In Practice
DOI
10.1016/j.jaip.2025.10.005
PMID
41167528
Abstract
Background: Real-world data on the benefit of high-dose inhaled corticosteroid (ICS) post-exacerbation are limited.
Objective: To investigate whether stepping-up to high-dose inhaled corticosteroid (ICS) post-severe exacerbation reduces future asthma exacerbation risk in a real-world setting.
Methods: This was a retrospective cohort study using the Optum® Clinformatics® database (October 2015-December 2023). Patients with asthma, aged ≥12 years, with ≥1 severe exacerbation and ≥2 ICS maintenance prescriptions in the 12-months pre-, and ≥1 ICS maintenance prescription in the 3-months post-exacerbation were included. Primary and secondary endpoints were annualized asthma exacerbation rate (AAER) and time to first subsequent severe exacerbation, respectively. We compared endpoints between ICS dose-changing patterns in the 3-month pre- and post-first eligible severe exacerbation: 1. low-to-high versus low-to-medium (low-dose cohort); 2. medium-to-high versus medium-to-medium (medium-dose cohort). Comparability of baseline characteristics was ensured by inverse probability of treatment weighting.
Results: 2,324 and 13,467 subjects were included in the low- and medium-dose cohorts, respectively. Stepping-up ICS from low-to-high versus low-to-medium-dose did not reduce AAER (rate ratio (RR): 0.896 [95% CI 0.738, 1.088]) and did not significantly increase time to next exacerbation (hazard ratio (HR): 0.869 [95% CI 0.720, 1.048]). Stepping-up ICS from medium-to-high versus medium-to-medium dose was associated with a significant increase in AAER (RR 1.169 [95% CI 1.023, 1.336]) and increased likelihood of experiencing an exacerbation (HR: 1.161 [95% CI 1.016, 1.325]). A similar pattern was noted when follow-up was restricted to a maximum of 12-months.
Conclusion: Post- severe exacerbation, stepping-up to high-dose ICS was not associated with reduced exacerbation risk in patients with persistent asthma. Other treatment strategies may prove to be better options in these patients.
Keywords
annualized severe asthma exacerbation rate, persistent asthma, real-world evidence, time to exacerbation
Published Open-Access
yes
Recommended Citation
Tran, Trung N; Kerkhof, Marjan; Le, Tham T; et al., "Association of Stepping-Up to High Dose Inhaled Corticosteroids and Risk of Future Asthma Exacerbations: Data From the US" (2025). Faculty and Staff Publications. 4595.
https://digitalcommons.library.tmc.edu/baylor_docs/4595