Is It Safe to Reduce Inhaled Corticosteroid Dose in Severe Asthma Patients Receiving Biologic Therapy?
Nagihan Orhan Özer, Betül Özdel Öztürk, Begüm Görgülü Akın, Ceren Kaplankıran, Şadan SoyyiğitABSTRACT
Background
Biologic therapies can control severe asthma and may modify its natural history beyond symptom control. However, step‐down is not standardized, and its safety has not been clearly established.
Methods
This single‐center retrospective cohort study reviewed adults with severe asthma on biologics (January 2019–May 2024). Step‐down strategies (discontinuation of add‐on therapy and/or inhaled corticosteroid [ICS] dose reduction) were described, success rates calculated, and clinical characteristics compared between groups with and without step‐down.
Results
Fifty‐one patients were included, of whom 10 (19.6%) received omalizumab, 34 (66.7%) mepolizumab, and 7 (13.7%) benralizumab. After excluding 6 patients unsuitable for step‐down assessment, 45 patients were compared. Step‐down was attempted in 21 of these (46.7%) and succeeded in 17 (81.0%), defined as no systemic corticosteroid use, emergency visit, loss of control (ACT < 20), or exacerbation through the last visit. The most frequent interventions were ICS dose reduction ( n = 7, 33.3%) and montelukast discontinuation ( n = 7, 33.3%). Biologics had been received for a mean of 42.6 ± 14.0 months, and the reduced regimen was maintained for 8.15 ± 5.23 months. Compared with the non–step‐down group, the step‐down group had a higher proportion of males ( p = 0.005) and longer follow‐up ( p = 0.007).
Conclusion
In this real‐world cohort, step‐down was feasible and appeared safe, with most patients maintaining the reduced regimen without deterioration in control or exacerbations. These findings support supervised treatment minimization in carefully selected, well‐controlled patients, adding real‐world evidence to a limited literature.