Effect of Stepping Up to High-Dose Inhaled Corticosteroids in Patients With Asthma: UK Database Study

BACKGROUND: It is unclear whether patients with asthma benefit from stepping up to high-dose inhaled corticosteroids (ICSs). OBJECTIVE: To determine the effectiveness of stepping up to high-dose ICSs.METHODS: A historic cohort study of patients with asthma (double dagger 13 years old), identified from 2 large UK electronic medical record databases, was conducted. Patients who remained on medium-dose ICSs were compared with those who stepped up from medium-to high-dose ICSs, whereas patients who stepped up from low-to medium-dose ICSs were compared with those who stepped up from low-to high-dose ICSs. Time to first severe exacerbation (primary outcome) between treatment groups was compared using multivariable Cox proportional hazards models, and the number of exacerbations and antibiotics courses was analyzed using negative binomial regression. Inverse probability of treatment weighting was used to handle confounding. RESULTS: The mean follow-up time to first exacerbation was 2.7 +/- 2.7 years for those who remained on stable medium-dose ICSs and 2.0 +/- 2.2 years for those who stepped up from me- dium-to high-dose ICSs. A similar pattern was noted for those who stepped up from low-to medium-dose ICSs (2.6 +/- 2.5 years) and from low-to high-dose ICSs (2.3 +/- 2.5 years). Pa-tients who stepped up from medium-to high-dose ICSs (n 6879) had a higher risk of exacerbations during follow-up compared with those who remained on medium-dose ICSs (n = 51,737; hazard ratio, 1.17; 95% CI, 1.12-1.22). This was similar in patients stepping up from low-to high-dose (n = 3232) compared with low-to medium-dose (n = 12,659) ICSs (hazard ratio, 1.10; 95% CI, 1.04-1.17). A step-up to high-dose ICSs was also associated with a higher number of asthma exacerbations and antibiotics courses. No significant difference in associations was found across sub-groups of patients with different blood eosinophil counts.CONCLUSIONS: We found no evidence that a step-up to high -dose ICSs is effective in preventing future asthma exacer-bations.(c) 2022 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immu-nology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). (J Allergy Clin Immunol Pract 2023;11:532-43)