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.
Biological Products ; Steroids ; Asthma