Oral Corticosteroids Tapering Protocol for Severe Asthma PDF

ORAL CORTICOSTEROIDS TAPERING PROTOCOL FOR SEVERE ASTHMA ORAL CORTICOSTEROIDS TAPERING PROTOCOL FOR SEVERE ASTHMA INTRODUCTION Systemic corticosteroids are commonly used for the management of severe asthma, either episodically for exacerbations, or chronically as maintenance therapy in patients wi...

ORAL CORTICOSTEROIDS TAPERING PROTOCOL FOR SEVERE ASTHMA ORAL CORTICOSTEROIDS TAPERING PROTOCOL FOR SEVERE ASTHMA INTRODUCTION Systemic corticosteroids are commonly used for the management of severe asthma, either episodically for exacerbations, or chronically as maintenance therapy in patients with poor response to inhaled therapies. However, chronic use of corticosteroids can lead to systemic side effects to the patients, such as osteoporosis, cardiovascular complications, diabetes, and obesity. It also poses a risk of inhibiting the adrenal glands' production of cortisol (also known as “adrenal insufficiency”). The risk of developing side effects with systemic corticosteroids increases with cumulative dose over time. New biologic treatments in severe asthma have emerged in recent years. These treatments have shown to be able to improve clinical outcomes, and at the same time, reduce the need for oral corticosteroids. With the use of biologics, the patients are able to reduce, and in most cases, eliminate oral corticosteroids completely. The study protocol from one of the OCS reduction studies, the PONENTE Study with the use of benralizumab in specific, provides an evidence-based guidance for individualized tapering and complete elimination of oral corticosteroids among severe asthma patients. The purpose of this protocol is to provide healthcare professionals a guidance on how to safely down-titrate oral corticosteroids doses in patients with severe asthma who is currently on chronic OCS therapy, and started on biologic treatment, following improvements of symptoms of asthma. Figure 1: Flow Chart to Taper Off OCS Doses 4 weeks after starting treatment with biologic Starting at a prednisone or prednisolone baseline dosage > 20 mg/day Reduce by 5 mg/day every week Starting at a baseline dosage After reaching 20 mg/day or > 10 to ≤20 mg/day Reduce by 5 mg/day every 2 weeks Starting at a baseline dosage After reaching 10 mg/day or > 7.5 to ≤10 mg/day Reduce by 2.5 mg/day every 2 weeks Starting at a baseline dosage After reaching 7.5 mg/day or > 5 to ≤7.5 mg/day Reduce by 2.5 mg/day every 4 weeks 5 mg/day for 4 weeks Cortisol evaluation (Figure 2) Adapted from PONENTE Trial: Menzies-Gow, Andrew, et al. ERJ open research 5.3 (2019).  Figure 2: Cortisol When Reaching A Prednisone Dose = 5 mg/day Prednisone dosage Morning cortisol 5 mg/day (8:00 – 9:00 h) Normal Indeterminate Complete AI >350 nmol/L (Indeterminate values) 450 nmol/L (Indeterminate values)