作者@article {Maijers1901147 = {Maijers Ingrid and Kearns, Nethmi and Harper, James and Weatherall, Mark and Beasley, Richard}, title = {Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma}, volume = {55}, number = {1}, elocation-id = {1901147}, year = {2020}, doi = {10.1183/13993003.01147-2019}, publisher = {European Respiratory Society}, abstract = {Background The proportion of the efficacy of high-dose inhaled corticosteroids (ICS) in oral corticosteroid-dependent asthma that is due to systemic effects is uncertain. This study aimed to estimate the ICS dose{\textendash}response relationship for oral corticosteroid-sparing effects in oral corticosteroid-dependent asthma, and to determine the proportion of oral corticosteroid-sparing effects due to their systemic effects, based on the comparative dose{\textendash}response relationship of ICS versus oral corticosteroids on adrenal suppression.Methods Systematic review and meta-analysis of randomised controlled trials reporting oral corticosteroid-sparing effects of high-dose ICS in oral corticosteroid-dependent asthma. In addition, reports of oral corticosteroid to ICS dose-equivalence in terms of adrenal suppression were retrieved. The primary outcome was the proportion of the oral corticosteroid-sparing effect of ICS that could be attributed to systemic absorption, per 1000 {\textmu}g increase of ICS, expressed as a ratio. This ratio estimates the oral corticosteroid sparing effect of ICS due to systemic effects.Results 11 studies including 1283 participants reporting oral corticosteroid-sparing effects of ICS were identified. The prednisone dose decrease per 1000 {\textmu}g increase in ICS varied from 2.1 mg to 4.9 mg, depending on the type of ICS. The ratio of the prednisone-sparing effect due to the systemic effects per 1000 {\textmu}g of fluticasone propionate was 1.02 (95\% CI 0.68{\textendash}2.08) and for budesonide was 0.93 (95\% CI 0.63{\textendash}1.89).Conclusion In patients with oral corticosteroid-dependent asthma, the limited available evidence suggests that the majority of the oral corticosteroid-sparing effect of high-dose ICS is likely to be due to systemic effects.In oral corticosteroid-dependent asthma, the majority of the oral corticosteroid-sparing effects of high-dose inhaled corticosteroids (ICS) are due to their systemic effects. Clinicians should be aware of this bioequivalence when prescribing high-dose ICS. http://bit.ly/2m0Fa8m}, issn = {0903-1936}, URL = {//www.qdcxjkg.com/content/55/1/1901147}, eprint = {//www.qdcxjkg.com/content/55/1/1901147.full.pdf}, journal = {European Respiratory Journal} }