Composite type-2 biomarker strategy vs. a symptom-risk-based algorithm to adjust corticosteroid dose in patients with severe asthma

A U.K. study compared two approaches to adjusting corticosteroid dose among adults with severe asthma. While current recommendations favor increasing the dose as a way to manage symptoms and reduce exacerbations, doing so could backfire in patients who do not present with corticosteroid responsive type-2 (T2)-driven eosinophilic inflammation.

A U.K. study compared two approaches to adjusting corticosteroid dose among adults with severe asthma. While current recommendations favor increasing the dose as a way to manage symptoms and reduce exacerbations, doing so could backfire in patients who do not present with corticosteroid responsive type-2 (T2)-driven eosinophilic inflammation. These individuals would not only benefit little but could suffer adverse effects. Researchers wondered, then, if a dose-decision strategy based on a composite score of T2 biomarkers would be more practical. To investigate, the team randomly assigned 240 trial participants to this approach and 61 others to a standardized symptom–risk-based algorithm. The primary endpoint was the share of participants in the intent-to-treat population with corticosteroid dose reduction at week 48. At followup, there was no significant between-group difference in this outcome. That was not the case in the per-protocol analysis, which included only 121 patients due to noncompliance with treatment advice. Among those who did follow recommendations, 30.7% of patients in the biomarker strategy group were on a lower corticosteroid dose at 48 weeks vs. 5% of the control patients. The study authors urge future research to focus on why patients ignored treatment recommendations.