P12 A FeNO-based strategy to guide oral corticosteroid initiation in patients with severe asthma experiencing an exacerbation whilst on treatment with anti-IL5/5R therapy. (11th November 2022)

• Record Type: Journal Article
• Authors: Lam, JL; Hearn, AP; Thomson, LA; Green, LM; Fernandes, M; Roxas, C; D'Ancona, G; Dhariwal, J; Nanzer, AM; Jackson, DJ
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A87
• Page End: A87
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.148
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Oral corticosteroids (OCS) have a poor adverse effect profile and their effectiveness relates to the presence of T2 inflammation in asthma. In patients treated with an anti-IL5/5R biologic, FeNO remains a useful biomarker of T2 inflammation and has the potential to guide OCS use. Results of the MEX study 1 support this, highlighting that in patients on Mepolizumab, a low FeNO identifies a non-eosinophilic exacerbation. The Nurse-led Rapid Access Review (RAR) service at our tertiary asthma centre routinely uses FeNO to guide OCS use in anti-IL5/5R treated patients. Specifically, OCS is largely withheld in the absence of a rise in FeNO above the patient's baseline level. Here we report on the outcome and safety of this approach. Methods: A retrospective analysis of all anti-IL5/5R treated patients presenting to the RAR clinic with an exacerbation of respiratory symptoms between June 2021 and June 2022 was performed. Clinical data including FeNO, blood eosinophil count, FEV1, ACQ-6, CRP and microbiological results was analysed. Any OCS use in the 7 days following the RAR visit was also documented. Results: Over the 1-year period, 49 patients (Benralizumab n= 37 Mepolizumab n= 12) established on anti-IL5/5R therapy attended our RAR service with symptoms consistent with an asthma exacerbation. At review, the mean (SD) ACQ6 was 3.5 (1.0), the median (IQR) blood eosinophil count was 0x10 9 (0–0.04) and median FeNO was 58ppb (37–114). 25/49 (51%) patients were treated with an acute course of OCS following assessment. The median FeNO of those treated was 102ppb (38–135) compared to 48ppb (37–64) in those not advised to commence OCS. Mean CRP was 16.2 mg/L (48.7) in the OCS treated patients, and 16.0 mg/L (34.6) in the non-OCS treated patients. 6/25 were prescribed antibiotics instead of OCS. None of the 25 patients in whom OCS was withheld went on to require OCS in the 7 days post follow-up. Conclusion: A FeNO-based strategy to guide acute OCS prescription in patients on anti-IL/5R therapies is a safe and effective means of minimising unnecessary systemic steroid exposure in patients experiencing exacerbations of airway symptoms. A randomised prospective study is now warranted to further evaluate this approach. References: McDowell PJ, Diver S, Yang F, Borg C, Busby J, Brown V, et al. Lancet Respir Med . 2021 Oct;9 (10):1174–1184.