Adrenal Suppression During Biologic-Facilitated Steroid Tapering in Severe Asthma: A Real-World Tertiary-Centre Experience
https://doi.org/10.15605/jafes.041.S1
- Author:
Sean Yi Xian Tay
1
;
Travers Brian Ramadass
1
;
Sakshi Malik
1
;
Shoaib Faruqi
1
Author Information
1. Hull University Teaching Hospitals Trust
- Publication Type:Journal Article
- MeSH:
Biological Products;
Steroids;
Asthma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):64-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:A significant proportion of severe asthma patients require
oral corticosteroids (OCS) to maintain symptom control.
Prolonged OCS predisposes patients to hypothalamicpituitary-adrenal axis suppression which can be lifethreatening. Biologic therapies are effective steroid-sparing
options suitable for select severe asthma patients. We
evaluated steroid tapering outcomes and adrenal function
during biologic therapy in a tertiary severe asthma clinic.
Results:A total of 43 patients were included. Median age was 66
years (interquartile range [IQR] 60–74), and 65% were male.
Mepolizumab was the most used (17 patients), followed
by benralizumab (15), tezepelumab (6), dupilumab (4),
and omalizumab (1). Median baseline prednisolone dose
was 10 mg (IQR 5–10). Median lowest dose achieved was
3 mg (IQR 0–3), sustained for at least 4 weeks in 90.7%
of patients. Median reduction in prednisolone dose was
5 mg (IQR 5–7.25). In all, 42% of patients successfully
discontinued maintenance steroids. Adrenal function was
assessed using morning serum cortisol (n = 37) and/or SST
(n = 28). Evidence of adrenal insufficiency was identified
in 19 patients (44%), including 15 patients with failed SST
and four with low morning cortisol suggestive of adrenal
suppression. Morning serum cortisol was indeterminate
in four patients. A total of 17 patients were referred to
endocrinology. During steroid tapering, 11 asthma-related
hospital admissions and eight emergency department
presentations occurred, involving 10 patients.
Conclusion:Biologics facilitate the reduction of the OCS burden in
severe asthma. Tertiary adrenal suppression is common
during steroid tapering and requires prompt biochemical
assessment and endocrinology referral. Structured
monitoring of adrenal function is essential during biologicfacilitated steroid tapering in routine clinical practice.
- Full text:2026080316305459335EP_A081.pdf
