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Late Breaking Abstract - Corticosteroid optimisation in severe asthma using composite biomarkers to adjust dose versus a symptom/risk-based algorithm

Tim Hardman, Liam Heaney, John Busby, Catherine Hanratty, Ratko Djukanovic, Ashley Woodcock, Samantha Walker, Joseph Arron, David Choy, Peter Bradding, Christopher Brightling, Rehka Chaudhuri, Douglas Cowan, Rob Niven, Stephen Fowler, Tim Harrison, Peter Howarth, Jim Lordan, Adel Mansur, Andrew Menzies-Gow, Douglas Robinson
European Respiratory Journal 2020 56: 4618; DOI: 10.1183/13993003.congress-2020.4618
Tim Hardman
1Niche Science &Technology Ltd, Kingston-Upon-Thames, United Kingdom
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  • For correspondence: tim.hardman@niche.org.uk
Liam Heaney
2Queen’s University, Belfast, United Kingdom
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John Busby
2Queen’s University, Belfast, United Kingdom
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Catherine Hanratty
2Queen’s University, Belfast, United Kingdom
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Ratko Djukanovic
3NIHR Southampton Biomedical Research Centre, Southampton, United Kingdom
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Ashley Woodcock
4Wythenshawe Hospital, Manchester, United Kingdom
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Samantha Walker
5Asthma UK, London, United Kingdom
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Joseph Arron
6Genentech, California,, United States of America
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David Choy
7Genentech, California, United States of America
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Peter Bradding
8University of Leicester, Leicester, United Kingdom
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Christopher Brightling
8University of Leicester, Leicester, United Kingdom
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Rehka Chaudhuri
9Gartnavel Hospital, Glasgow, United Kingdom
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Douglas Cowan
10Stobhill Hospital, Glasgow, United Kingdom
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Rob Niven
11Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Stephen Fowler
11Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Tim Harrison
12University of Nottingham, Nottingham, United Kingdom
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Peter Howarth
13University of Southampton, Southampton, United Kingdom
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Jim Lordan
14Newcastle upon Tyne NHS Foundation Trust, Newcastle, United Kingdom
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Adel Mansur
15University of Birmingham and Heartlands Hospital, Birmingham, United Kingdom
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Andrew Menzies-Gow
16Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
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Douglas Robinson
17University College Hospitals NHS Foundation Trust, London, United Kingdom
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Abstract

Introduction: Increasing corticosteroids (CS) to control asthma symptoms and exacerbations has potential for inappropriately high and difficult to down-titrate CS doses.

Aims and Objectives: We tested whether a T2 biomarker-based strategy (BS) to guide CS reduction (factoring fractional exhaled nitric oxide (FeNO), blood eosinophils, serum periostin) vs. a symptom-based control would see fewer exacerbations and better asthma control and lung function.

Methods: In this randomised (4:1/BS:control), single-blind parallel group trial, patients (pts) with severe asthma and FeNO <45 ppb were given group specific instruction on CS adjustment every 8 wks. The primary outcome was proportion of pts achieving CS reduction at Wk48. Secondary outcomes included exacerbation rate, lung function and asthma control.

Results: In the intention-to-treat population (240 BS vs. 61 control pts), the proportion of BS pts on lower CS dose at Wk48 was 28.4% vs. 18.5% in the controls (adjusted OR: 1.71; 95%CI 0.80, 3.63; p=0.165). In the per protocol (PP) population (n=121), significantly more pts had lower CS doses at Wk48 in the BS vs. the control group (30.7% vs. 5.0% (OR: 11.48; 95%CI 1.35, 97.83; p=0.026). Failure to follow treatment advice was the main reason for ITT and PP population differences. There was no difference in secondary outcomes between study arms.

Conclusion: Biomarker based CS adjustment did not result in a greater proportion of pts reducing CS vs. control, probably because many pts did not follow treatment advice. The biomarker strategy seemed beneficial in pts where symptoms and T2 biomarker profile were discordant.

Footnotes

Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 4618.

This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2020
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Late Breaking Abstract - Corticosteroid optimisation in severe asthma using composite biomarkers to adjust dose versus a symptom/risk-based algorithm
Tim Hardman, Liam Heaney, John Busby, Catherine Hanratty, Ratko Djukanovic, Ashley Woodcock, Samantha Walker, Joseph Arron, David Choy, Peter Bradding, Christopher Brightling, Rehka Chaudhuri, Douglas Cowan, Rob Niven, Stephen Fowler, Tim Harrison, Peter Howarth, Jim Lordan, Adel Mansur, Andrew Menzies-Gow, Douglas Robinson
European Respiratory Journal Sep 2020, 56 (suppl 64) 4618; DOI: 10.1183/13993003.congress-2020.4618

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Late Breaking Abstract - Corticosteroid optimisation in severe asthma using composite biomarkers to adjust dose versus a symptom/risk-based algorithm
Tim Hardman, Liam Heaney, John Busby, Catherine Hanratty, Ratko Djukanovic, Ashley Woodcock, Samantha Walker, Joseph Arron, David Choy, Peter Bradding, Christopher Brightling, Rehka Chaudhuri, Douglas Cowan, Rob Niven, Stephen Fowler, Tim Harrison, Peter Howarth, Jim Lordan, Adel Mansur, Andrew Menzies-Gow, Douglas Robinson
European Respiratory Journal Sep 2020, 56 (suppl 64) 4618; DOI: 10.1183/13993003.congress-2020.4618
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