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The prevalence of supratherapeutic ICS use and its impact on corticosteroid-related comorbidities is poorly understood. 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients from the nationwide Danish Severe Asthma Register (DSAR) receiving biologic therapy\u2009&gt;\u200912 months were included. Supratherapeutic doses were defined as\u2009&gt;\u20091600 \u00b5g\n                      <jats:italic>budesonide<\/jats:italic>\n                      daily. Baseline characteristics, comorbidity burden, and change in ICS use after 12 months of biologic therapy was stratified according to ICS use at baseline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>vs<\/jats:italic>\n                      8.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025. No differences in other corticosteroid-related comorbidities were observed.\n                    <\/jats:p>\n                    <jats:p>\n                      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\u2009&gt;\u200980% adherence at 12 months, compared to 83% at baseline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00408-025-00796-5","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T13:30:19Z","timestamp":1741699819000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Supratherapeutic Inhaled Corticosteroid Use in Patients Initiating on Biologic Therapies for Severe Asthma: A Nationwide Cohort Study"],"prefix":"10.1007","volume":"203","author":[{"given":"Frederikke","family":"Hjortdahl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne Baastrup","family":"Soendergaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Sofie","family":"Bjerrum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"von B\u00fclow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole","family":"Hilberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bonnesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus Rikard","family":"Johnsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie Lock","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda Makowska","family":"Rasmussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes Martin","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte Suppli","family":"Ulrik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Byriel","family":"Walls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Porsbjerg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjell Erik Julius","family":"H\u00e5kansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"issue":"179","key":"796_CR1","doi-asserted-by":"publisher","first-page":"114112","DOI":"10.1016\/j.bcp.2020.114112","volume":"1","author":"A C\u00f4t\u00e9","year":"2020","unstructured":"C\u00f4t\u00e9 A, Godbout K, Boulet LP (2020) The management of severe asthma in 2020. 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ASB has received personal fees from AstraZeneca, GSK and Sanofi. MBS has received personal fees from GSK, AstraZeneca and ALK-Abello outside of the submitted work. KEJH has received personal fees from AstraZeneca, Chiesi, GSK, Sanofi and TEVA. CSU has received personal fees from AstraZeneca, GSK, TEVA, TFF Pharmaceuticals, Pfizer, Chiesi, Sanofi Genzyme, Boehringer-Ingelheim, Orion Pharma, Novartis, ALK-Abello, Mundipharma and Actelion. CP has received personal fees and research support from AstraZeneca, GSK, Novartis, Sanofi, Teva and ALK. LMR and CRJ none. ABW none. FH none.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"42"}}