Ann Allergy Asthma Immunol. 2026 Apr 3:S1081-1206(26)00148-1. doi: 10.1016/j.anai.2026.03.026. Online ahead of print.
ABSTRACT
BACKGROUND: Anti-Interleukin 5/Rα (IL5/Rα) for severe asthma has demonstrated marked reductions in systemic corticosteroid use. However, little is known about the long-term total (inhaled and systemic) corticosteroid exposure.
OBJECTIVE: Estimate total corticosteroid exposure reduction and prevalence of corticosteroid remission over five years of anti-IL5/Rα therapy for severe asthma.
METHODS: All Danish adults initiating anti-IL5/Rα for severe asthma during 2016-2019 were followed for five years. Corticosteroid exposure was assessed annually using national registries, and changes were estimated using mixed models. Corticosteroid remission was defined as no systemic corticosteroid exposure and low-to-moderate daily inhaled corticosteroid doses.
RESULTS: In total, 253 patients were included (median age 57, 51% female). At baseline, 33% were using daily maintenance oral corticosteroids. The year prior to biologic therapy, median total corticosteroid exposure was 3,604mg (3,404, 3,803) prednisolone equivalents. Year one, total corticosteroid exposure was reduced by 25.2% (13.4, 36.9) increasing to a reduction of ∼45% years three through five. Systemic corticosteroids accounted for the majority of reductions, with decreases of 32.8% (21.1-44.6) during the first year and ∼60% during later years. For inhaled corticosteroids, statistically significant reductions were observed during year four at -149.7mcg (-13.7, -285.7) budesonide-equivalents and -189.1mcg (-23.2, -355.1) during year five. During later treatment years, inhaled corticosteroids represented the main source of corticosteroid exposure. An annual average of 23% achieved corticosteroid remission, while only 2.4% achieved five-year sustained corticosteroid remission.
CONCLUSION: Over five years, anti-IL5/Rα treatment significantly reduced total corticosteroid exposure. Reductions were driven by marked reductions in systemic corticosteroid exposure, whereas modest reductions in inhaled corticosteroid exposure were observed.
PMID:41936962 | DOI:10.1016/j.anai.2026.03.026
