Oral Corticosteroid Prescription In Asthma: Swiss Situation

Introduction: Severe refractory asthma is characterized by a higher risk of asthma-related symptoms and exacerbations. Airway eosinophilia is present in most asthmatic patients, and elevated levels of blood and sputum eosinophils are associated with worse asthma control. Since patients with eosinophilic asthma respond to OCS we investigated the prescription pattern for Switzerland. 1-2g prednisone equivalent/year is associated with long-term side effects and incremental health-care costs. Methods: This is a retrospective study of anonymized patient level prescription data from Swiss pharmacies (IQVIA Swiss pharmacy LRx® database) during the period of Nov. ’16 to Oct. ‘19. Asthma patients were classified based on patient gender, age and historic medication by a predictive model trained on prescription data with diagnoses (IQVIA Disease Analyzer®, IQVIA Germany). Results: 8.145 patients were identified with at least one asthma specific prescription in each year of the inclusion period. From these 10-11% had an OCS prescription in each year, 21% at least once. In 779 patients receiving OCS in the last year, 8% received OCS due to comorbidities other than asthma, 79% were classified as using OCS in the acute setting and 14% chronically based on pill possession rate (>100 pills/year). For chronic users OCS median yearly cumulative dose was 2.000mg prednisone equivalent, the median in the acute setting was 400mg. 23% of all OCS patients received more than 1.000mg prednisone equivalent OCS per year. Conclusion: In Switzerland OCS prescriptions in asthma patients is mainly for acute use. However, every 4th patient receiving OCS fulfills prescriptions with a cumulative dose of >1g per year and should be evaluated for biologic therapy.