Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

Ann Allergy Asthma Immunol. 2020 Sep;125(3):294-303.e1. doi: 10.1016/j.anai.2020.04.004. Epub 2020 Apr 15.


Background: Severe asthma (SA) often requires subspecialist management and treatment with biologic therapies or maintenance systemic corticosteroids (mSCS).

Objective: To describe contemporary, real-world biologic and mSCS use among US subspecialist-treated patients with SA.

Methods: CHRONICLE is an ongoing, noninterventional study of US adults with SA treated by allergists/immunologists or pulmonologists. Eligible patients are receiving biologics or mSCS or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers. Biologic and mSCS use patterns and patient characteristics were summarized for patients enrolled between February 2018 and February 2019.

Results: Among protocol-eligible patients, 58% and 12% were receiving biologics and mSCS, respectively, with 7% receiving both. Among 796 enrolled, most were women (67%), non-Hispanic white (71%), of suburban residence (50%), and had elevated body mass index (median: 31). Respiratory and nonrespiratory comorbidities were highly prevalent. With biologics (n = 557), 51% were anti-immunoglobulin E and 48% were anti-interleukin (IL)-5/IL-5Rα; from May 2018, 76% of initiations were anti-IL-5/IL-5Rα. In patients receiving mSCS, median prednisone-equivalent daily dose was 10 mg. Multivariate logistic regression found that patients of hospital clinics, sites with fewer nonphysician staff, and with a recorded concurrent chronic obstructive pulmonary disease diagnosis were less likely to receive biologics and more likely to receive mSCS.

Conclusion: In this real-world sample of US subspecialist-treated patients with SA not controlled by high-dosage inhaled corticosteroids with additional controllers, mSCS use was infrequent and biologic use was common, with similar prevalence of anti-immunoglobulin E and anti-IL-5/IL-5Rα biologics. Treatment differences associated with patient and site characteristics should be investigated to ensure equitable access to biologics and minimize mSCS use.

Trial registration: Identifier: NCT03373045.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / metabolism
  • Biological Products / therapeutic use*
  • Female
  • Humans
  • Immunoglobulin E / metabolism
  • Interleukin-5 / metabolism
  • Interleukin-5 Receptor alpha Subunit / metabolism
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / metabolism
  • Young Adult


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Biological Products
  • Interleukin-5
  • Interleukin-5 Receptor alpha Subunit
  • Immunoglobulin E

Associated data