Prevalence of the use of oral corticosteroids in asthma – a 3 year analysis in Germany

Background: Long-term treatment with oral corticosteroids (OCS) in severe asthma is currently debated due to a variety of potential severe side effects and alternative treatment options such as biologics. However, the current prevalence of frequent OCS use in Germany is incompletely understood.

Methods: We studied the percentage of asthma patients in Germany (> 18 y) treated with OCS in 2015 (Y1), 2016 (Y2), 2017 (Y3). Patients with 2 confirmed asthma diagnoses/year (Y1 – 3) were identified from German IMS^® database which is an electronic medical records database covering 1289 general practitioners (GPs) and 28 respiratory physicians (RPs). Asthma medication, corresponding treatment steps (according to German disease management guideline 2018) and cumulative use of OCS > 30 days/year (d/y) were examined.

Results: Records of 30 310 (Y1), 29 478 (Y2), 28 466 (Y3) patients identified at GPs and 11 642 (Y1), 11 580 (Y2), 11 439 (Y3) patients identified at RPs were analysed. Based on prescribed inhaled therapies, 31% (Y1), 31.2% (Y2), 31.6% (Y3) (GP) and 38.6% (Y1), 40.1% (Y2), 39.0% (Y3) (RP) of patients were assignable to treatment step 4, and 3.1% (Y1), 3% (Y2), 2,7% (Y3) (GP) and 3.3% (Y1), 3.5% (Y2), 3.4% (Y3) (RP) to step 5. Irrespective of treatment step (1 – 5), GPs treated 9.2% (Y1), 9.5% (Y2) and 8.8% (Y3) and RPs 6.3% (Y1), 6.4% (Y2) and 6.2% (Y3) of patients with OCS > 30 d/y.

Conclusion: Despite new treatment options for severe asthma in Germany, the prevalence of OCS > 30 d/y is still relatively high. Of note, OCS use was not confined to patients with maximal inhalation therapy, suggesting that treatment escalation according to current guidelines was not performed in a substantial proportion of patients.