D2.87 - Disease Burden of Severe Asthma Patients Treated with Medium and High Doses of ICS: A Regional Database Analysis from China

The Global Strategy for Asthma Management and Prevention (GINA) emphasizes targeted therapies (e.g. biologics) for asthma patients treated with high-dose inhaled corticosteroids (ICS). However, data on the disease burden among those on medium doses of ICS is sparse, creating a gap in guidance for targeted therapy in this group.

Patients aged ≥12 years with severe asthma, defined by ICD-10 codes and having at least two prescriptions for medium- or high-dose ICS within the prior six months, were identified from the Shanghai Medical Database (2016-2020). Patients were grouped by the most recent ICS prescription meeting severe asthma criteria, with the day after defined as the index date. Key variables including baseline characteristics, comorbidities, exacerbation occurrence, oral corticosteroids (OCS), healthcare resource utilization (HCRU) due to exacerbations, and associated medical costs within one year post-index were analyzed.

A total of 35900 severe asthma patients (mean age 57.2±16.2 years; 50.9% female) were identified. Of these, 32119 (89.5%) received medium-dose ICS and 3781 (10.5%) received high-dose ICS before index date. The high-dose group was relatively older, had more males, and observed a higher proportion of patients with eczema compared to medium-dose group, but a lower proportion of patients with Allergic rhinitis (Table 1). After excluding outliers, 11.4% of the medium-dose group experienced exacerbations, with an average frequency of 2.8±3.6 per year, an annualized exacerbation rate of 0.7 (95% CI: 0.7-0.8), and an OCS use rate of 3.0% (cumulative dose 594.0±802.4 mg). Patients in the high-dose group exhibited a higher exacerbation rate (14.4%), frequency (3.2±4.2), annualized exacerbation rate (1.1, 95% CI: 1.1-1.2), and more OCS use (5.2%, 690.1±934.1 mg), with all p<0.05 except OCS dose (p=0.212). HCRU for medium- and high-dose ICS group included outpatient visits (2.4%, 4.0%), emergency room visits (6.4%, 7.4%), and hospitalization (4.6%, 6.1%) due to exacerbations, with total asthma costs of 8806.4±19059.6 Chinese Yuan (CNY) and 10805.2±23771.8 CNY, respectively (all p<0.05).

Severe asthma patients treated with high-dose ICS exhibit more frequent exacerbations, increased OCS use, and elevated medical costs. Notably, the medium-dose ICS group also demonstrates a significant disease burden. These findings underscore both patients should be taken seriously for optimized management to reduce exacerbations and alleviate disease burdens.