OBJECTIVES: To describe the burden of oral corticosteroid (OCS) use in patients with asthma initiating treatment with biologics.

METHODS: A retrospective cohort study was conducted with patients with asthma who initiated biologics between January 2017 and March 2022, using Optum’s de-identified Clinformatics® Data Mart Database. Differences in OCS use, measured OCS prescription (Rx) count, average daily dose, average prescription count, and average days supplied during the 12 month baseline period were described. Maintenance OCS (mOCS) was defined as Rx with >28 days. Patients with an index biologic prescription from a “dermatology” provider were excluded.

RESULTS: Out of 9,273 patients with asthma who initiated biologics, 21.22% (n= 1,968) were on mOCS. Most mOCS patients were 45 to 64 years old (50.98%; non-mOCS: 37.67%). Users of mOCS were more likely to have Medicare coverage (52.95% vs. 38.84%), higher Charlson Commorbidity Index (2.0 vs. 1.7), higher proportion of respiratory infections (64.8% vs. 55.7%) and COPD (50.0% vs. 28.56%). Conversely, non-mOCS users had higher frequency of allergic rhinitis (70.49% vs. 60.06%), atopic dermatitis (27.23% vs. 14.18%), chronic idiopatic urticaria (11.75% vs. 6.71%), and nasal polyps (16.13% vs. 13.26%). The average prescription count for any OCS during baseline was 7.04 (SD: 4.28) for mOCS and 2.80 (SD: 2.95) for non-mOCS. The average OCS daily dose for mOCS was 7.80 mg (SD: 5.93). Across all prescription counts, mOCS group had an average of 24.07 (SD: 21.11) OCS days supplied per prescription compared to 8.76 (SD: 4.79) days for non-mOCS.

CONCLUSIONS: Overall, mOCS use prior to biologic initiation in patients with asthma was high, indictive of substantial patient and health system burden.