代谢型与未控制儿童哮喘、肠道微生物群和全身炎症相关性研究
2025/06/27
摘要
背景：在重度哮喘中，通常使用高剂量（“超治疗”）吸入性糖皮质激素（ICS）。目前关于超治疗性ICS使用的普遍性及其对皮质类固醇相关并发症的影响知之甚少。
目的：本研究旨在描述超治疗性ICS在严重哮喘中的使用率，其与皮质类固醇相关并发症的关系，以及生物治疗12个月后开具和回收ICS剂量的变化。
方法：本研究纳入丹麦全国严重哮喘登记处（DSAR）接受生物治疗>12个月的患者。超治疗ICS剂量定义为每天>1600µg布地奈德。根据基线时ICS的使用情况，对基线特征、共病负担和生物治疗12个月后ICS使用的变化进行分层。
结果：本研究共纳入了652名患者，其中156名（24%）在开始生物治疗之前应用超治疗性ICS。超治疗ICS患者的基线白内障患病率较高（14%对8.1%；p=0.025）。未观察到其他皮质类固醇相关并发症的差异。经过12个月的生物治疗后，处方超治疗性ICS的患病率没有变化。然而，本研究观察到超治疗患者的ICS依从性降低，72%的患者在12个月时依从性>80%，而基线时为83%（p<0.001）。
结论：在开始生物治疗之前，近四分之一的患者使用了ICS的超治疗剂量，并且与白内障的患病率较高有关。医生驱动的ICS减少很少见，但发现超治疗性ICS用户在接受生物治疗时可自我调整ICS治疗。
Supratherapeutic Inhaled Corticosteroid Use in Patients Initiating on Biologic Therapies for Severe Asthma: A Nationwide Cohort Study.
Hjortdahl F, Soendergaard MB, Hansen S, Bjerrum AS, von Bülow A, Hilberg O, Bonnesen B, Johnsen CR, Johansson SL, Rasmussen LM, Schmid JM, Ulrik CS, Walls AB, Porsbjerg C, Håkansson KEJ.
Abstract
BACKGROUND:
In severe asthma, intensive ("supratherapeutic") doses of inhaled corticosteroids (ICS) are often used. The prevalence of supratherapeutic ICS use and its impact on corticosteroid-related comorbidities is poorly understood.
OBJECTIVES:
We aimed to describe the prevalence of supratherapeutic ICS use in severe asthma, its relation to corticosteroid-related comorbidities, and changes in prescribed and redeemed ICS dose after 12 months of biologic therapy.
METHODS:
Patients from the nationwide Danish Severe Asthma Register (DSAR) receiving biologic therapy >12 months were included. Supratherapeutic doses were defined as > 1600 µg budesonide daily. Baseline characteristics, comorbidity burden, and change in ICS use after 12 months of biologic therapy was stratified according to ICS use at baseline.
RESULTS:
We included 652 patients in our analyses and 156 (24%) were supratherapeutic ICS users prior to initiation of biologic therapy. Supratherapeutic ICS users had a higher baseline prevalence of cataracts at 14 vs 8.1%; p = 0.025. No differences in other corticosteroid-related comorbidities were observed. No change in prevalence of prescribed supratherapeutic ICS was seen after 12 months of biologic therapy. However, a reduction in ICS adherence among supratherapeutic users was observed with 72% of patients demonstrating >80% adherence at 12 months, compared to 83% at baseline (p< 0.001).
CONCLUSION:
Supratherapeutic doses of ICS were used by almost one-fourth of the patients prior to initiation of biologic therapy and were associated with a higher prevalence of cataracts. Physician-driven ICS reduction was rare, yet supratherapeutic ICS users were found to self-regulate ICS therapy when treated with biologic therapy.
背景：在重度哮喘中，通常使用高剂量（“超治疗”）吸入性糖皮质激素（ICS）。目前关于超治疗性ICS使用的普遍性及其对皮质类固醇相关并发症的影响知之甚少。
目的：本研究旨在描述超治疗性ICS在严重哮喘中的使用率，其与皮质类固醇相关并发症的关系，以及生物治疗12个月后开具和回收ICS剂量的变化。
方法：本研究纳入丹麦全国严重哮喘登记处（DSAR）接受生物治疗>12个月的患者。超治疗ICS剂量定义为每天>1600µg布地奈德。根据基线时ICS的使用情况，对基线特征、共病负担和生物治疗12个月后ICS使用的变化进行分层。
结果：本研究共纳入了652名患者，其中156名（24%）在开始生物治疗之前应用超治疗性ICS。超治疗ICS患者的基线白内障患病率较高（14%对8.1%；p=0.025）。未观察到其他皮质类固醇相关并发症的差异。经过12个月的生物治疗后，处方超治疗性ICS的患病率没有变化。然而，本研究观察到超治疗患者的ICS依从性降低，72%的患者在12个月时依从性>80%，而基线时为83%（p<0.001）。
结论：在开始生物治疗之前，近四分之一的患者使用了ICS的超治疗剂量，并且与白内障的患病率较高有关。医生驱动的ICS减少很少见，但发现超治疗性ICS用户在接受生物治疗时可自我调整ICS治疗。
（中日友好医院呼吸与危重症医学科 张婧媛 摘译 林江涛 审校）
（Lung. 2025 Mar 11;203(1):42. doi: 10.1007/s00408-025-00796-5. PMID: 40069448; PMCID: PMC11897081.）
Supratherapeutic Inhaled Corticosteroid Use in Patients Initiating on Biologic Therapies for Severe Asthma: A Nationwide Cohort Study.
Hjortdahl F, Soendergaard MB, Hansen S, Bjerrum AS, von Bülow A, Hilberg O, Bonnesen B, Johnsen CR, Johansson SL, Rasmussen LM, Schmid JM, Ulrik CS, Walls AB, Porsbjerg C, Håkansson KEJ.
Abstract
BACKGROUND:
In severe asthma, intensive ("supratherapeutic") doses of inhaled corticosteroids (ICS) are often used. The prevalence of supratherapeutic ICS use and its impact on corticosteroid-related comorbidities is poorly understood.
OBJECTIVES:
We aimed to describe the prevalence of supratherapeutic ICS use in severe asthma, its relation to corticosteroid-related comorbidities, and changes in prescribed and redeemed ICS dose after 12 months of biologic therapy.
METHODS:
Patients from the nationwide Danish Severe Asthma Register (DSAR) receiving biologic therapy >12 months were included. Supratherapeutic doses were defined as > 1600 µg budesonide daily. Baseline characteristics, comorbidity burden, and change in ICS use after 12 months of biologic therapy was stratified according to ICS use at baseline.
RESULTS:
We included 652 patients in our analyses and 156 (24%) were supratherapeutic ICS users prior to initiation of biologic therapy. Supratherapeutic ICS users had a higher baseline prevalence of cataracts at 14 vs 8.1%; p = 0.025. No differences in other corticosteroid-related comorbidities were observed. No change in prevalence of prescribed supratherapeutic ICS was seen after 12 months of biologic therapy. However, a reduction in ICS adherence among supratherapeutic users was observed with 72% of patients demonstrating >80% adherence at 12 months, compared to 83% at baseline (p< 0.001).
CONCLUSION:
Supratherapeutic doses of ICS were used by almost one-fourth of the patients prior to initiation of biologic therapy and were associated with a higher prevalence of cataracts. Physician-driven ICS reduction was rare, yet supratherapeutic ICS users were found to self-regulate ICS therapy when treated with biologic therapy.
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