SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)
Assessment of an oral corticosteroid withdrawal pathway for severe asthma patients receiving biologic therapies
Hnin Aung 1,2 , Richard Russell 1,2 , Claire Boddy 2 , Kumaran Balasundaram 2 , Eleanor Hampson 2 , Mark Bell 2 , Lauren Parnell 2 , Michelle Bonnington 2 , Syed Mohammad 2 , Miles Levy 3 , Karim Meeran 4 , Salman Siddiqui 5 , Shamsa Naveed 1,2 & Peter Bradding 1,2
1Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom; 2University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 3Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 4Faculty of Medicine, Imperial College, London, United Kingdom; 5National Heart and Lung Institute, Imperial College, London, United Kingdom
Background: The optimal approach for weaning maintenance oral corticosteroids (mOCS) in severe asthma patients receiving biologics remains unclear. Previous studies assessed hypothalamic-pituitary-adrenal function at 5 mg daily prednisolone, a supraphysiologic dose for many, necessitating further mOCS reduction for adrenal recovery.
Aim: We evaluated a protocol-driven nurse-led mOCS withdrawal pathway for severe asthma patients receiving biologics.
Methods: Severe asthma patients receiving biologics and mOCS, who had reduced mOCS to 5 mg prednisolone daily and maintained good asthma control, entered the withdrawal pathway. Prednisolone was decreased to 4 mg daily for 6 weeks then 3 mg daily for 6 weeks, followed by 09.00 serum cortisol measurement. Patients with cortisol > 25 nmol/l followed a 20-week weaning protocol. Serum cortisol was re-checked 12 weeks after stopping mOCS.
Results: Of 102 patients, 92 had cortisol > 25 nmol/l on 3 mg prednisolone and continued weaning. Seventy-three (72%) successfully discontinued mOCS with median [IQR] cortisol increasing from 192 [88-299] nmol/l on 3 mg prednisolone to 314 [248-437] nmol/l 12 weeks after discontinuation (P < 0.0001). Twenty-nine patients (28%) paused weaning due to adrenal insufficiency symptoms (n = 22), worse asthma control (n = 1), anxiety (n = 2) and other reasons (n = 4). The baseline cortisol in this group was 53 [25-166] nmol/l, and they are currently well receiving median 3 [3-3.9] mg prednisolone. Duration of prior OCS use was significantly shorter in the successfully weaned group compared to those who failed (P = 0.003). No serious adverse events occurred.
Conclusion: The majority of clinically stable asthma patients receiving biologics successfully withdrew mOCS without requiring dynamic adrenal function testing. This confirms that referral to Endocrinology is not helpful in patients who need withdrawal from prednisolone.
Volume 109
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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