Oral corticosteroids and biologics use in the Greek Severe Asthma Registry (GSAR)

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Background-aims: Data regarding the treatment of severe asthma (SA) patients with maintenance OCS (mOCS) and biologics in Greece is limited. Our study aims to address this gap. Methods: We analyzed data regarding OCS and biologic use in SA patients from the GSAR of the Hellenic Thoracic Society. Results: 619 patients were analyzed, 19% of whom were on mOCS. The majority (65%) of patients were female, with a mean age of 57.3 years, and 68% had late-onset asthma (LOA), with a median duration of 21 years. Patients on mOCS had less well-controlled asthma (ACT ≥20; 35.8 vs 64%), worse lung function (FEV1% 66.1 vs 74.1) and higher exacerbation rate (2.63 vs 1.89) compared to the non-mOCS group. GERD and osteoporosis were the most common comorbidities in the mOCS group. Biologics were receiving 57% of patients (61% female, mean age of 56.8 years), 67% of whom had late-onset asthma and 22% were also on mOCS. Patients on biologics had better asthma control (ACT≥20;61.8 vs 50.5) despite having higher exacerbations rate in the previous year (2.24 vs 1.43) and worse pulmonary function (FEV1%, 73 vs 81) than those not receiving biologics. Atopy, nasal polyposis and GERD were more common among biologics’ users compared to the non-biologics group (75.6 vs 60.2%, 31.5 vs 16.4% and 33.4 vs 22.4%, respectively). Notably, biologic switchers (60.5%) had higher rates of exacerbations (2.99 vs 2.05) and allergic rhinitis (74 vs 61.3%). Conclusions: Although the majority of SA asthma patients in the GSAR receive biologics, a significant proportion are still on mOCS. The administration of biological therapies in appropriately selected patients may result in better clinical outcomes with fewer OCS-related side effects.

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