Assessment of an oral corticosteroid withdrawal pathway for severe asthma patients receiving biologic therapies
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
The optimal approach to weaning maintenance oral corticosteroids (mOCS) in patients with severe asthma receiving biologics remains unclear. Previous studies assessed hypothalamic–pituitary–adrenal function at 5 mg daily prednisolone, a supraphysiologic dose for many, necessitating further mOCS reduction for adrenal recovery.
Objective
We evaluated a protocol-driven, nurse-led mOCS withdrawal pathway with clinical oversight for patients with severe asthma receiving biologics.
Methods
Patients with severe asthma receiving biologics, who had reduced mOCS to 5 mg prednisolone daily and maintained good asthma control, entered the withdrawal pathway. Prednisolone was decreased to 4 mg daily for 6 weeks and then 3 mg daily for 6 weeks, followed by 09.00 serum cortisol measurement. Patients with cortisol greater than 25 nmol/L followed a 20-week weaning protocol. Serum cortisol was rechecked 12 weeks after stopping mOCS.
Results
Of 102 patients, 92 had cortisol greater than 25 nmol/L with 3 mg prednisolone and continued weaning. A total of 73 (72%) successfully discontinued mOCS with median (interquartile range) cortisol increasing from 192 (88-299) nmol/L with 3 mg prednisolone to 314 (248-437) nmol/L at 12 weeks after discontinuation (P < .0001). Twenty-nine patients (28%) paused weaning owing to adrenal insufficiency symptoms (n = 22), worse asthma control (n = 1), anxiety (n = 2), and other reasons (n = 4). The baseline cortisol in this group was 53 (25-166) nmol/L, and patients are currently well and receiving a median of 3.0 (3.0-3.9) mg prednisolone. Duration of prior oral corticosteroid use was significantly shorter in the group that was successfully weaned compared with those who failed weaning (P = 0.003). No serious adverse events occurred.
Conclusion
Most clinically stable patients with asthma receiving biologics successfully withdrew mOCS without requiring dynamic adrenal function testing.
The optimal approach to weaning maintenance oral corticosteroids (mOCS) in patients with severe asthma receiving biologics remains unclear. Previous studies assessed hypothalamic–pituitary–adrenal function at 5 mg daily prednisolone, a supraphysiologic dose for many, necessitating further mOCS reduction for adrenal recovery.
Objective
We evaluated a protocol-driven, nurse-led mOCS withdrawal pathway with clinical oversight for patients with severe asthma receiving biologics.
Methods
Patients with severe asthma receiving biologics, who had reduced mOCS to 5 mg prednisolone daily and maintained good asthma control, entered the withdrawal pathway. Prednisolone was decreased to 4 mg daily for 6 weeks and then 3 mg daily for 6 weeks, followed by 09.00 serum cortisol measurement. Patients with cortisol greater than 25 nmol/L followed a 20-week weaning protocol. Serum cortisol was rechecked 12 weeks after stopping mOCS.
Results
Of 102 patients, 92 had cortisol greater than 25 nmol/L with 3 mg prednisolone and continued weaning. A total of 73 (72%) successfully discontinued mOCS with median (interquartile range) cortisol increasing from 192 (88-299) nmol/L with 3 mg prednisolone to 314 (248-437) nmol/L at 12 weeks after discontinuation (P < .0001). Twenty-nine patients (28%) paused weaning owing to adrenal insufficiency symptoms (n = 22), worse asthma control (n = 1), anxiety (n = 2), and other reasons (n = 4). The baseline cortisol in this group was 53 (25-166) nmol/L, and patients are currently well and receiving a median of 3.0 (3.0-3.9) mg prednisolone. Duration of prior oral corticosteroid use was significantly shorter in the group that was successfully weaned compared with those who failed weaning (P = 0.003). No serious adverse events occurred.
Conclusion
Most clinically stable patients with asthma receiving biologics successfully withdrew mOCS without requiring dynamic adrenal function testing.
Date Issued
2025-07-01
Date Acceptance
2025-03-30
Citation
Journal of Allergy and Clinical Immunology: In Practice, 2025, 13 (7), pp.1807-1815.E4
ISSN
2213-2198
Publisher
Elsevier
Start Page
1807
End Page
1815.E4
Journal / Book Title
Journal of Allergy and Clinical Immunology: In Practice
Volume
13
Issue
7
Copyright Statement
© 2025 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40209926
PII: S2213-2198(25)00313-7
Subjects
Adrenal insufficiency
Allergy
Asthma
Cortisol
Immunology
Life Sciences & Biomedicine
Maintenance
Oral corticosteroids
OUTCOMES
Prednisolone
PREVALENCE
Science & Technology
Weaning
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-04-08