Data from new national study exposes oral corticosteroids overuse in Canadian patients with severe asthma
- 72% of people with uncontrolled severe asthma had substantial OCS use.
MISSISUAGA, ON - The data from the real-world evidence study “Characterizing uncontrolled severe asthma in Canada (ALERT)” was recently presented at the American College of Chest Physicians Annual Meeting (CHEST) and the European Respiratory Society Congress (ERS). The study offers a better understanding of the use of oral corticosteroids (OCS) by Canadians with uncontrolled severe asthma and highlights their unmet medical needs.
Uncontrolled severe asthma is a type of asthma that does not respond well to inhaled medicines alone and requires assessment by a specialist [i]. In Canada, OCS, along with inhaled medications, have been an important treatment option for managing severe asthma. However, OCS are known to increase the risk of short- and long-term adverse effects, even at low doses (equivalent to 1-2 courses) [ii]. Other medicines, such as injectable biologics, can be used to treat uncontrolled severe asthma and have demonstrated OCS-reducing effects.
The data from the ALERT study showed most people with uncontrolled severe asthma had substantial OCS use but were not on available biologic therapy, highlighting a significant gap in the management of severe asthma. This emphasizes the need for better education of healthcare providers and improved patient awareness of treatment options.
The study was conducted by GSK in collaboration with Asthma Canada and with Dr. Susan Waserman, McMaster University and Dr. Andréanne Côté, Quebec Heart and Lung Institute and Université Laval, with contract research support, input and analytics provided by IQVIA Solutions Canada Inc.
“In an era with so many available treatment options for asthma it is appalling to witness such a high rate of OCS overuse. Better identification of uncontrolled patients and easier access to treatment optimization should be a top priority in the care of those patients,” said Dr. Andréanne Côté.
“Recognizing the alarming OCS overuse is a step in the right direction to raise awareness among practitioners and patients of alternative treatment options for asthma management. Further education could enhance the adoption of these treatments to optimize outcomes,” said Dr. Susan Waserman.
“The findings of the ALERT study highlight the need to recognize OCS overuse in Canada. It is fundamental to continue educating patients and healthcare practitioners about treatment options to protect people from OCS overuse and optimize asthma management,” said Jeffrey Beach, President & CEO, Asthma Canada
Key findings of the ALERT study include:
- 5% of asthma patients were classified as having severe asthma.
- Of those with severe asthma, 12.7% were classified as uncontrolled severe asthma.
- 72% of patients with uncontrolled severe asthma were not on available biologic therapy.
- 40% of patients with uncontrolled severe asthma had four or more OCS courses.
- Some regions in Canada have much higher OCS use per person than other regions.
An abstract of the ALERT study will be published in the European Respiratory Journal in November 2024. GSK has a longstanding dedication of more than 50 years in respiratory health, initiatives like the ALERT study further underscore our commitment to getting ahead of respiratory disease.
About Asthma
Asthma is a chronic inflammatory disease of the airways that causes symptoms like shortness of breath, chest tightness, coughing and wheezing. Asthma causes inflammation and narrowing of the bronchial tubes, which leads to limited airflow and difficulty breathing [iii].
About severe asthma
Severe asthma is defined as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller (and/or systemic corticosteroids) or biologic therapy, to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite treatment [iv]. It is estimated that as many as 465,000 Canadians suffer from severe asthma, which represents approximately 5-10% of the general asthma population [v]. Severe asthma can have several underlying causes including Type 2 inflammation [iv]. It is estimated the cost of asthma to the Canadian economy will climb to $4.2 billion by 2030 [v].
About OCS
Oral corticosteroids (OCS) are systemic anti-inflammatory medications used to manage inflammatory conditions, including respiratory diseases, and allergic reactions. Unlike inhaled corticosteroids (ICS), which target the lungs directly, OCS are ingested and distributed throughout the body. Common types include prednisone, methylprednisolone, and hydrocortisone.
Historically, daily OCS were essential for treating severe or uncontrolled asthma, but with the availability of biologic therapies, the recommendation for OCS has shifted primarily to managing asthma attacks. The use of OCS, including in repeated short bursts, can lead to significant health risks, and has led to OCS-sparing asthma management strategies. The wide range of adverse effects associated with OCS include increased risk of infection and cardiovascular events, osteoporosis, type 2 diabetes mellitus, weight gain, and mood and behaviour disturbances. A recent Canadian study found consensus that patients who have used 2 or more courses of OCS and/or is using maintenance OCS therapy over the past 12 months despite adherence to high dose inhaled therapy should be referred to a specialist [vi-ix].
About ALERT
The ALERT (chAracterizing uncontroLled sevERe asThma in Canada) study is a research initiative focused on understanding how uncontrolled severe asthma is managed in Canada. Utilizing data from IQVIA Private Drug Plan database, the study examined prescription claim patterns for OCS and biologics from April 2020 to June 2023. In this study, uncontrolled severe asthma is specifically defined as severe asthma that requires two or more claims for OCS within a one-year observational period, indicating poor control despite standard treatments.
About Asthma Canada
Asthma Canada is the only national healthcare charity dedicated to improving the quality of life for people living with asthma and respiratory allergies.
About GSK
GSK is a global biopharma company with a purpose to unite science, technology, and talent to get ahead of disease together. For further information please visit www.ca.gsk.com/en-ca.
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References
[i] Narasimhan K. Am Fam Physician. 2021;103:286–9
[ii] Skov IR, Madsen H, et al. Low-dose oral corticosteroids in asthma associates with increased morbidity and mortality ERJ 2022 60: 2103054. Low-dose oral corticosteroids in asthma associates with increased morbidity and mortality | European Respiratory Society (ersjournals.com)
[iii] Asthma Canada: What is Asthma? Understanding Asthma - Asthma Canada
[iiv] Global Initiative for Asthma. 2024 GINA Report. 2024 GINA Main Report - Global Initiative for Asthma - GINA (ginasthma.org)
[v] Asthma Canada: Severe Asthma Severe Asthma - Asthma Canada
[vi] Chan, JSK, Murray RB, Price D. Oral corticosteroids in asthma and beyond: moving forward ERJ. 2022; 60:2200776. Oral corticosteroids in asthma and beyond: moving forward | European Respiratory Society (ersjournals.com)
[vii] Price DB, Trudo F, et al. Adverse outcomes from initiation of systemic corticosteroids: long-term observational study J Asthma Allergy. 2018;11:193-204. https://doi.org/10.2147/JAA.S176026
[viii] Asthma Canada: Oral Corticosteroids for Asthma Oral Corticosteroids for Asthma - Asthma Canada
[ix] Godbout K, Bhutani M et al. Recommendations from a Canadian Delphi consensus study on best practice for optimal referral and appropriate management of severe asthma. Allergy Asthma Clin Immunol. 2023 Feb 17;19(1):12. Recommendations from a Canadian Delphi consensus study on best practice for optimal referral and appropriate management of severe asthma | Allergy, Asthma & Clinical Immunology | Full Text (biomedcentral.com)
