Asthma

Biomarker-based steroid reduction difficult to achieve in real world


Use of a biomarker-based strategy to safely reduce corticosteroid use in severe asthma did not show a significant impact – possibly because a high number of patients failed to follow treatment advice, according to UK researchers.

Presenting their results at the European Respiratory Society 2020 Virtual Conference, they said it had been hoped that use of the T2 biomarker strategy – which takes into account blood eosinophil count, serum periostin, and fractional exhaled nitric oxide (FENO) concentration – would identify patients with severe asthma who could safely reduce corticosteroid dose.

The UK multi-centre study of 300 patients seen at eight-week intervals found 28·4% of patients in the biomarker strategy group reduced their dose of corticosteroid at 48 weeks compared with 18·5% of patients in the control group whose treatment was based on symptoms alone.

When researchers analysed the data in the overall intention to treat population, they found no significant difference between the biomarker or control strategies.

However, in a Lancet Respiratory Medicine paper published to coincide with the conference, the authors said they found a significantly greater proportion of patients reducing their corticosteroid treatment in the biomarker strategy group compared with the control group when they confined the analysis to 121 patients who completed the treatment protocol.

Speaking at the ERS2020 Virtual Conference, study author Professor Liam Heaney from Queen’s University Belfast said the principal reason for the difference in findings was the high proportion of patients who chose not to follow treatment advice as well as big variation between centres on adherence.

But he added that it meant the researchers could study the consequences which were apparent for both not reducing or increasing treatment as directed.

“In those who did not follow treatment advice there was a significant increased risk of severe exacerbation,” he said.

Understanding the reasons why patients did not follow treatment advice would be important for future research, he told delegates.

The data did show that use of a biomarker-adjusted corticosteroid strategy seems particularly beneficial in those patients where symptoms and T2 biomarker profile are discordant, the researchers said.

“Our overall conclusion is we should consider before progression to high-dose steroid treatment, really earlier, using predictive biomarkers of therapeutic response to try guide these treatment decisions because our study suggests that once established on high-dose corticosteroids, biomarker driven dose reduction can be difficult to achieve,” said Professor Heaney.

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