HCPs, patients willing to trade off OCS benefits to avoid side effects

Both patients and healthcare professionals prefer treatment for asthma attacks that avoids the side effects of oral corticosteroids (OCS), and both are willing to trade off benefits, according to a study.

“In clinical practice, the risk–benefit balance of OCS should feature in shared decision-making discussions with patients experiencing outpatient asthma attacks,” the researchers said. “The findings also support developing trials to personalize acute asthma treatment.”

A discreet choice experiment (DCE) was performed involving patients with asthma and HCPs in the UK and New Zealand. Logit models were used to analyse their preferences. A total of 824 patients and 171 HCPs completed the DCE.

Avoidance of permanent side effects showed the greatest influence on treatment preference by both patients and HCPs, with the former giving greater weight to it. However, those with uncontrolled asthma were more prepared to exchange risk for the benefit of treatment. [Respirology 2025;30:1035-1045]

The most valued clinical benefit to patients and HCPs was symptom recovery. Moreover, the former preferred “improving lung function” over “avoiding additional GP treatment or hospitalization,” while the latter preferred avoidance of further healthcare utilization.

"Based on their responses, we estimated the minimum clinically important difference for the treatment failure outcome at 20 percent,” the researchers said.

Negative impression

These findings supported those of earlier studies. For instance, a previous survey in the UK found that most patients experienced side effects from OCS and that HCPs underestimated the frequency of these side effects. [npj Prim Care Respir Med 2015;25:15026]

Likewise, a mixed methods study showed extensive side effects from OCS that affected the patients’ quality of life and resulted in psychosocial burden and social stigma. [Ann Allergy Asthma Immunol 2023;131:745-751]

Another survey in France that assessed patient perception of OCS showed that only 40 percent felt OCS to be efficacious, while 80 percent noted side effects. [J Asthma 2021;58:946-957]

"Most patients had a negative impression of OCS and were not satisfied with the side effect information provided by their doctor,” the researchers said.

Further research

The current findings also indicate the need for more research into treatments and management that reduce acute OCS exposure, according to the researchers, noting that the main goal is still prevention of asthma attacks with anti-inflammatory treatment while reducing the risk from lifestyle factors.

“However, breakthrough attacks still occur, and the underlying pathology may not always be steroid-responsive,” they said. [Am J Respir Crit Care Med 2008;178:218-224]

Treatment with OCS may have reduced clinical efficacy in outpatient attacks with low type-2 inflammation and thus an unfavourable risk–benefit balance to patients, according to the researchers. [Lancet 2002;360:1715-1721]

“Biomarker-directed, placebo-controlled trials offer the opportunity to rationalize OCS treatment in those with least benefit, a concept already explored in chronic obstructive pulmonary disease attacks,” they added. [Eur Respir J 2022;60:4728] 

On the other hand, the rapidly acting and long-duration anti-IL-5Rα monoclonal antibody benralizumab has been shown to be a potential alternative to OCS in breakthrough attacks with type-2 inflammation. [Lancet Respir Med 2025;13:59-68]

“Our DCE results suggest that evaluation of acute treatment leading to lower exposure to OCS side effects would be valued by both patients and HCPs,” the researchers said.