Steroid Burden Research Articles

Diabetes Mellitus in Patients With Autoimmune Hepatitis: Frequency, Risk Factors and Effect on Outcome.

Treatment for autoimmune hepatitis (AIH) includes corticosteroids, which are associated with the development of diabetes mellitus (DM). Reported new-onset DM rates in patients with AIH have varied, and predisposing factors and prognostic implications are inadequately characterised. To identify the frequency and predisposing factors for DM in AIH and its association with disease progression and mortality. Retrospective/prospective single-centre study of 494 patients with AIH presenting 1987-2023, 466 receiving corticosteroids (454 prednisolone, 12 budesonide) and followed for (median (range) 9 (0-36) years). Forty-seven patients (10%) already had DM at AIH diagnosis. New-onset DM subsequently developed in another 59 (13%). In those receiving prednisolone, new-onset DM incidence was 8% ± 1% after 1 year and 14% ± 2% after 10 years (14- and 3-fold higher than expected population rate), and was independently associated with older age, non-Caucasian ethnicity, higher initial prednisolone dose, higher BMI at diagnosis and more weight gain after 2 years of follow-up. New-onset DM usually persisted despite stopping prednisolone. New-onset DM and DM at any time were independently associated with all-cause death/transplantation rate, along with previously established risk factors (older age, cirrhosis, lower ALT at diagnosis and failure of early ALT normalisation). New-onset DM and DM at any time were also independently associated with cirrhosis development. Similar associations of new-onset DM and DM at any time with liver-related death/transplantation were significant on univariate but not multivariate analysis. New-onset DM occurred in 13% of patients with AIH, was related to older age, non-Caucasian ethnicity, higher prednisolone dose, higher BMI at diagnosis and weight gain; and was an independent predictor of all-cause death/transplantation and of cirrhosis development, underlining the need to minimise steroid burden in AIH.

P003 Immune checkpoint inhibitor-induced rheumatic adverse events - a single centre retrospective cohort study

Abstract Background/Aims Over the last decade, immune checkpoint inhibitor (ICI) use in cancer treatment has rapidly increased, leading to dramatically improved cancer progression-free and overall survival rates. The development of immune-related adverse events (irAEs), including autoimmune rheumatic disease is common. Reporting of rheumatic irAEs has been variable and to our knowledge a UK cohort has not yet been described from the rheumatology perspective. Methods We undertook a retrospective cohort analysis of all adult patients commencing ICI therapy at the Royal United Hospitals Bath between August 2016 and December 2022. Patients with pre-existing rheumatic disease were excluded. Routinely collected clinical data were reviewed until December 2023, 6 months after discontinuation of ICI, or patient death, whichever occurred first. Results 636 patients were identified as having received ICI treatment at the RUH during the study period. 78 patients were excluded. Of the patients included 233/558 were female. 451/558 patients identified as White British. The most common cancer diagnoses were lung, melanoma and renal. Pembrolizumab monotherapy and nivolumab monotherapy were the most common ICI treatments given. Rheumatic irAEs were reported in 43/558 patients. Of those, 25/43 developed symptoms within 6 months and 35/43 within 12 months of initiating ICI therapy. 6/43 discontinued ICI therapy due to a rheumatic irAE. Arthralgia was the most reported symptom (32/43). 22/43 developed objective features of inflammatory arthritis, of which 14 had polyarthritis and 8 oligoarthritis. 18/43 were referred to Rheumatology. Treatment: 32/43 patients received systemic steroids. The average total cumulative dose was equivalent to prednisolone 2367 mg with an average daily dose of 11.2 mg/day. Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) were given to 3 patients, of which 1 was due to proceed to biologic therapy (bDMARD) but did not start due to cancer progression. The average cumulative and daily steroid doses for these 3 patients was equivalent to prednisolone 6980 mg and 12.3 mg/day. A further patient was due to initiate bDMARD as first line therapy but did not do so due to patient concerns about the risk of disease progression. Conclusion In our cohort, 8% of patients developed a rheumatic irAE, of which 53% developed objective features of inflammatory arthritis. The majority occurred within 12 months of commencing ICI treatment. 74% of patients received steroids though only 51% had documented objective evidence of inflammatory arthritis. The overall steroid burden in these patients is high and carries associated potential risks. The use of DMARDs was low during the study period though post hoc analysis shows this to be increasing. This likely reflects increasing clinician confidence in the use of DMARDs and recognition of the required long-term use of steroids for these patients. Increasing collaboration between Oncologists, Rheumatologists and the patient will be crucial to optimising care. Disclosure M. Ho: None. E. Gates: None. F. Cheese: None. G. Gullick: None. T. Tillet: None. L. Dumas: None. A. Allard: Honoraria; A.A. has received honoraria from Abbvie, Bristol Myers Squibb, Eli Lilly, Novartis, Pfizer and Roche.

P011 Improving access to specialist rheumatology care for cancer patients with checkpoint inhibitor-related arthralgia or arthritis

Abstract Background/Aims The use of immune checkpoint inhibitors (CPIs) for cancer treatment has risen. CPIs cause immune activation, which can adversely cause inflammation in healthy tissues, including joints. Up-to 40% of patients report arthralgia, with CPI-induced inflammatory arthritis occurring in up to 7%. Many require corticosteroids and in severe cases, CPI may be discontinued. Prompt rheumatology assessment is essential for diagnosis and specialist management, potentially reducing corticosteroid burden, and preventing CPI interruption. We aimed to improve access to rheumatology assessment by establishing a dedicated clinical service. Methods We analysed patients referred to rheumatology at Leeds Teaching Hospitals Trust (LTHT) between 2020-2021 prescribed CPIs (pembrolizumab, ipilimumab, nivolumab, durvalumab, atezolizumab, avelumab, cemiplimab, tremelimumab). Patients under rheumatology with pre-existing inflammatory arthritis were excluded. Patient records were assessed for time taken between initial CPI-related arthralgia documentation to rheumatology referral and clinic review, and whether corticosteroids were started before rheumatologist assessment. In April 2022, we set up a dedicated service for CPI-related arthralgia/arthritis (‘intervention’) via direct patient referral to a rheumatology registrar with two dedicated clinic slots per week. We examined patient records seen between 2022-2024 to evaluate access to specialist care following this intervention. Chi-square tests were used for comparisons. Results 10 of 15 patients (67%) pre-intervention started corticosteroids from oncology before rheumatology review, with a median delay of 48 days from referral to rheumatology clinic. Post-intervention, only 6/29 (21%) patients started corticosteroids before rheumatology assessment (table 1). The median delay between referral to review in our dedicated service was 19 days, significantly improved from the pre-intervention group(p < 0.05). The delay between documented arthralgia to rheumatology referral from oncology was over 30 days in both groups. Conclusion Our dedicated clinical service has improved access to specialist care and significantly reduced delays to rheumatology review. With improved access, we demonstrate a significant reduction in corticosteroid initiation before specialist review, facilitating earlier diagnosis and reducing steroid burden. However, delay between patients reporting arthralgia to rheumatology referral remains >30 days, highlighting the need for improved education for oncologists. These data highlight the value of a direct access clinical pathway in lowering corticosteroid exposure and ensuring prompt rheumatological assessment for these patients. Disclosure B. Sethi: None. K. Harnden: None. K. Mankia: None.

A Real-World Study of Cumulative Steroid Burden Among Patients with Eosinophilic Esophagitis in the United States.

A Real-World Study of Cumulative Steroid Burden Among Patients with Eosinophilic Esophagitis in the United States.

P1091 Trends in length of stay and steroid use in patients admitted with Acute Severe Ulcerative Colitis: Impact of intensified or accelerated infliximab dosing

Abstract Background The role of intensified (>5mg/kg), accelerated (>1 dose within first 14 days) infliximab (IFX) as rescue therapy in patients with acute severe ulcerative colitis (ASUC) remains controversial. This project evaluated the association between evolving strategies with length of stay, 12-month cumulative steroid burden, colectomy and readmission rates. Methods Patients admitted with ASUC between January 2016 and October 2024 to a single tertiary IBD centre were identified and reviewed. IFX rescue therapy was defined as standard dose if up to 5mg/kg or intensified/accelerated if ≥10mg/kg (further categorised as 10mg/kg or ≥20mg/kg) was administered within 14 days of admission. Outcomes assessed included length of stay, 12-month cumulative steroid exposure (in prednisolone mg equivalent), 12-month readmission and colectomy rates. Results 147 patients (61 [41.5%] female, median age 33 [range 16-87] years) met Truelove and Witts criteria for ASUC. 83 (56.5%) patients required IFX therapy, of whom 29 (34.9%) patients received 5mg/kg IFX dose, 35 (30.1%) patients received 10mg/kg and 19 (22.9%) patients ≥20mg/kg. Disease severity as defined by CRP:albumin ratio was similar between patients receiving 5mg/kg vs 10mg/kg (p=0.880), but higher in those receiving 20mg/kg vs 5mg/kg (p=0.012); vs 10mg/kg (p=0.008). There was an increasing trend in the proportion of patients receiving intensified/accelerated IFX (≥10mg/kg) from 2016-2019 (26.3%) to 2020-2024 (76.5%) (p<0.001). Length of stay was less in patients who received 5mg/kg and 10mg/kg compared to ≥20mg/kg (median 6 vs 6 vs 11 days p=0.001). 12-month cumulative steroid usage was similar in 5mg/kg (median 1850 mg), 10mg/kg (1642.5 [1297.5-1935]mg) and ≥20mg/kg (1600 [1452.5-1715]mg), p=0.135. Readmission (19.2% (5mg/kg), 28.6% (10 mg/kg) and 11.1% (≥20mg/kg), p=0.527) and colectomy (8.7% (5mg/kg), 10.5% (10 mg/kg), 12.5% ≥20mg/kg, p = 0.958) rates were similar across IFX groups. Median length of stay was similar (p=0.193) between 2016-2019 (6 days) and 2020-2024 (6 days). 12-month cumulative steroid exposure (median 1705mg vs 1617.5mg, p=0.282) and readmission rates (15.8% vs 21.2%, p=0.488) remained stable when comparing 2016-2019 and 2020-2024. 12-month colectomy rates[MG1] declined across all ASUC patients (15.8% in 2016-2019 to 1.5% in 2020-2024, p = 0.004), and ASUC patients receiving IFX (21.1% 2016-2019 to 2.8% in 2020-2024, p = 0.025). Conclusion Despite higher disease severity, intensified and accelerated dosing for IFX at ≥20mg/kg resulted in similar length of hospital stay, 12-month steroid exposure, readmission and colectomy rates to lower doses. Intensified and accelerated IFX dosing has increased over time, associated with reduction in colectomy rate.

The Impact of FDA-Approved Novel Agents for Steroid-Refractory Chronic Graft vs. Host Disease on Treatment Patterns and Outcomes—A Single-Center Longitudinal Cohort Analysis

Objectives—chronic graft vs. host disease (cGVHD) is associated with substantial morbidity and mortality. We aimed to analyze advances in treatment strategy and outcomes during the last decade due to the incorporation of novel immunosuppressive therapy (IST) drugs in the armamentarium. Methods—we retrospectively analyzed all patients > 18 years with cGVHD after their first hematopoietic cell transplantation (HCT) between 2012 and 2020 (n = 91), divided into three treatment periods: 2012–2014, 2015–2017, and 2018–2020 (groups 1, 2, and 3, respectively). Results—mean cumulative steroid dose and dose/total cGVHD-treatment days was lower in groups 2–3 compared to 1 (p = 0.008 and p = 0.042, respectively). The median IST-free survival was 79 (95%CI54–94) months, with more patients in group 3 (47% (95%CI 25–54%) discontinuing IST at 3 years, p = 0.1). Groups 2–3 compared to 1 had better glycemic control (p < 0.01), higher bone density (p = 0.06), and fewer cardiovascular events. The number of admissions/patient dropped from 0.7/year in group 1 to 0.24/year and 0.36/year in groups 2–3, respectively (p = 0.36). Employment reintegration was higher in groups 2–3 compared with 1 (p = 0.05) and so was earlier return to work (p = 0.01). There were no differences in survival outcomes. Conclusions—the incorporation of novel agents appears to be associated with reduced overall steroid burden, improved cGVHD control, and fewer long-term side effects.

Cardiac sarcoidosis: diagnosis and management.

Non-caseating granulomatous infiltration of the myocardium is the hallmark of cardiac sarcoidosis (CS). CS manifests clinically as conduction disturbance, ventricular arrhythmia, sudden cardiac death and/or heart failure with reduced ejection fraction. Other than confirmation through endomyocardial biopsy, a diagnosis of probable CS can be established by histological evidence of systemic sarcoidosis in addition to characteristic clinical or advanced imaging findings. Cardiac Magnetic Resonance imaging (CMR) and 18F-flurodeoxyglycose positron emission tomography (FDG-PET) are imaging modalities indispensable in the diagnosis and monitoring of CS. FDG-PET is the method of choice for identifying the active inflammatory phase of CS and in the monitoring and modifying of immunosuppressive treatment. CMR is better suited for assessing cardiac morphology and function. Both modalities are more effective in detecting CS when used in combination than either is alone. Management of CS is primarily based upon observational data of low quality due to a paucity of randomized controlled trials. Corticosteroid therapy and/or tiered-immunosuppression are the mainstays of treatment in reducing myocardial inflammation. Steroid-sparing agents aim to limit the unfavorable side-effects of a significant steroid burden. Antiarrhythmics and guideline-directed medical therapies are utilized for control of ventricular arrhythmia and left ventricular dysfunction respectively. CS necessitates multidisciplinary care in specialized centers to most effectively diagnose and manage the disease. Additional randomized trials are warranted to further our understanding of medical optimization in CS.

E009 An audit looking into bisphosphonate co-prescription and compliance in patients with giant cell arteritis

Abstract Background/Aims The treatment of giant cell arteritis includes glucocorticoid use to reduce inflammation. There are known drawbacks of long-term glucocorticoid use, including osteopenia and osteoporosis. The British Society for Rheumatology giant cell arteritis guidelines recommend that we should consider appropriate pharmacological bone protection at the time of presentation to counteract this. Glucocorticoid toxicity risks increases with both dosage and duration of steroid use. To reduce steroid burden, we consider introduction of the steroid sparing agents such as tocilizumab and methotrexate. This audit was to look into whether we were locally achieving bone protection consideration and to whether steroid sparing agents were helping in terms of compliance of bisphosphonates. Methods We retrospectively looked at the clinical letters of the patients locally diagnosed with giant cell arteritis in the previous 3 years to ascertain whether there was documentation of decisions around starting bisphosphonates at the time of diagnosis and whether the patients tolerated bisphosphonate therapy for the recommended duration. Patients were classified into 3 groups, as to whether their treatment was glucocorticoids with tocilizumab (TOC), glucocorticoids with methotrexate (MTX) or glucocorticoid monotherapy (MONO). Results 49 Patients were identified. 3 of these patients were excluded for various reasons. 17 were in the TOC group, 11 in the MTX group, and 18 in the MONO group. Documentation of consideration of bisphosphonates at diagnosis was 94% in TOC, 91% in MTX and 100% in MONO. Overall this was 96%. Compliance of bisphosphonate therapy for the recommended duration was 88% in TOC, 90% in MTX and 86% in MONO. Overall compliance was 88%. There was no statistically significant difference between the steroid sparing groups and the monotherapy group both in terms of consideration of initiation of bisphosphonate treatment and compliance of bisphosphonate treatment, with p values of 0.52 and 0.8 respectively. Conclusion Overall, we found that locally there was good consideration of bisphosphonate therapy at diagnosis and that compliance remained good throughout treatment. This can help reduce the side effect profile of glucocorticoid toxicity. Although, there was no statistically significant difference in our study of concordance of bisphosphonates between the two groups, steroid sparing agents are useful in our arsenal at reducing the risks of glucocorticoid toxicity. Disclosure A.A. Bolger: None. L. Hutton: None.

Mepolizumab in children and adolescents with severe eosinophilic asthma not eligible for omalizumab: a single Center experience

Background Mepolizumab is an anti-interleukin-5 monoclonal antibody shown to reduce asthma exacerbations in adults and adolescents with severe eosinophilic asthma. Aim To assess the impact of mepolizumab on children and adolescents over 12 months by examining steroid usage, asthma-related hospitalizations, Asthma Control Test (ACT) scores, fractional exhaled nitric oxide concentration (FeNO), forced expiratory volume in 1 s (FEV1), mid expiratory flow (FEF25–75%), and blood eosinophil count. Methods Retrospective analysis performed between October 2015 and December 2022. Data was reviewed 12 months before and after commencing mepolizumab. Mepolizumab was offered if the patient had severe eosinophilic asthma and were unresponsive to or ineligible for omalizumab. Results Sixteen participants (age 7–17, 8 males, 8 females) received subcutaneous mepolizumab monthly with no serious adverse reactions. Incidence of hospital admissions fell significantly (IRR 0.33, p = 0.007). Among the 11 patients receiving daily oral corticosteroids, 3 were weaned off daily oral steroids and 3 patients’ daily dose was significantly reduced (mean Δ-0.095 ± 0.071 mg/kg, p = 0.0012). Eosinophil count was decreased (mean Δ-0.85 x 109/L, p < 0.001). There was no significant change in mean overall steroid burden per patient (mean Δ-1445.63 ± 1603.18 mg, p = 0.10), ACT scores (mean Δ2.88 ± 6.71, p = 0.17), FEV1 z-scores (mean Δ-0.99 ± 1.88, p = 0.053), FEF25–75% z-scores (mean Δ-0.65 ± 1.61, p = 0.13), FeNO (mean Δ-20.09 ± 80.86, p = 0.34), or number of courses of oral steroids given for asthma attacks (IRR 0.71, p = 0.09). Conclusion Among children and adolescents with severe eosinophilic asthma ineligible for or not responsive to omalizumab, mepolizumab therapy exhibited significant reduction in rate of asthma-related hospitalizations and significant decrease in daily steroid dosage.

Polymyalgia rheumatica - an up-to-date review on diagnosis and management

Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease in those over the age of 50 years. Previously it was considered to be a benign clinical syndrome characterised by subacute onset bilateral shoulder and pelvic girdle pain and stiffness, with a corresponding rise in acute phase reactants, and distinctive rapid resolution of symptoms with the instigation of moderate doses of glucocorticoids. However, over the past decade, with the advancements and, indeed, wider application of imaging modalities in PMR, we have garnered an increased understanding of the anatomic predilection of inflammation and, subsequently, disease pathogenesis. Moreover, our appreciation of the relationship between PMR and giant cell arteritis (GCA) has strengthened. Glucocorticoids have formed the cornerstone of the management of PMR for decades, with often protracted treatment durations and associated high cumulative steroid burden and adverse effects. However, we are now on the cusp of a new era in the management of PMR, with our therapeutic armamentarium expanding with the recent FDA approval of the interleukin -6 antagonist sarilumab for the management of refractory disease. It is an exciting time for PMR, and this review aims to explore the recent advancements in both diagnosis and management, while also providing an updated perspective on the relationship between PMR and GCA.

OA14 The role of anifrolumab in treating life threatening systemic lupus erythematosus with severe mucocutaneous involvement

OA14 The role of anifrolumab in treating life threatening systemic lupus erythematosus with severe mucocutaneous involvement

Factors associated with long-term healthcare expense and steroid exposure in patients admitted with acute severe ulcerative colitis.

Acute severe ulcerative colitis (ASUC) remains a significant cause of morbidity and healthcare utilization. This study aimed to characterize the total healthcare costs of ASUC, explore factors associated with significant cost over the 12 months following an index admission, and document outcomes including corticosteroid exposure. Patients admitted from January 2016 until January 2021 for ASUC to a tertiary inflammatory bowel disease (IBD) center in Australia were identified via retrospective chart review. Costs were calculated over a 12-month period following index admission. Seventy-two patients (30 [42%] female, median age 39 [IQR 27-54] years) were included. The median length of stay of index admission was 6 days (IQR 5-10 days). The median cost of index admission was 7829 AUD, which was driven by the initial length of stay (P < 0.01) and requirement for colectomy (P < 0.01). Median total healthcare cost over the first 12 months was 13 873 AUD (IQR 9684-19 936 AUD), again predominately driven by the length of stay (P < 0.01) and requirement for colectomy (P < 0.01). Median cumulative corticosteroid use over 12 months inclusive of index hospitalization was 1760 mg (IQR 1560-2350 mg). Requirement for inpatient medical salvage therapy with infliximab was associated with increased corticosteroid requirement (P = 0.01). Healthcare expense related to ASUC remains high, driven predominantly by the length of stay during initial hospitalization and need for colectomy. From a healthcare cost perspective, novel methods to reduce inpatient hospital stay as well as need for colectomy may help reduce the economic and steroid burden of ASUC.

Giant cell arteritis: A population-based retrospective cohort study exploring incidence and clinical presentation in Canterbury, Aotearoa New Zealand.

To determine the epidemiology and clinical features of giant cell arteritis (GCA) in Canterbury, Aotearoa New Zealand, with a particular focus on extra-cranial large vessel disease. Patients with GCA were identified from radiology and pathology reports, outpatient letters and inpatient hospital admissions in the Canterbury New Zealand from 1 June 2011 to 31 May 2016. Data was collected retrospectively based on review of electronic medical records. There were 142 cases of GCA identified. 65.5% of cases were female with a mean age of 74.2 years. The estimated population incidence for biopsy-proven GCA was 10.5 per 100,000 people over the age of 50 and incidence peaked between 80 and 84 years of age. 10/142 (7%) people were diagnosed with large vessel GCA, often presenting with non-specific symptoms and evidence of vascular insufficiency including limb claudication, vascular bruits, blood pressure and pulse discrepancy, or cerebrovascular accident. Those with limited cranial GCA were more likely to present with the cardinal clinical features of headache and jaw claudication. Patients across the two groups were treated similarly, but those with large vessel disease had greater long-term steroid burden. Rates of aortic complication were low across both groups, although available follow-up data was limited. This study is the first of its kind to describe the clinical characteristics of large vessel GCA in a New Zealand cohort. Despite small case numbers, two distinct subsets of disease were recognized, differentiating patients with cranial and large vessel disease. Our results suggest that utilization of an alternative diagnostic and therapeutic approach may be needed to manage patients with large vessel disease.

S477 A Real World Study of Cumulative Steroid Burden in Patients With Newly Diagnosed Eosinophilic Esophagitis

S477 A Real World Study of Cumulative Steroid Burden in Patients With Newly Diagnosed Eosinophilic Esophagitis

Capturing total steroid burden in patients with atopic dermatitis and asthma.

Background: The cumulative burden of cutaneous, inhaled, intranasal and systemic corticosteroids (CS) in individual patients should be routinely assessed. Methods: Our monitoring tool collected data on CS type, potency, frequency, side effects, interventions and patient counseling in every encounter. Results: 82 AD patients had 151 encounters. Severe AD had more side effects than those without (68.18% vs 41.67% respectively, P < 0.0333). Those with higher TSB had more side effects overall (p < 0.0493). There was also significant positive correlation with higher TSB and the overall number of side effects (p < 0.0116). 101 asthmatics had 193 encounters. Over 50% of asthma patients had other CS. Severe asthmatics had more side effects than those without (62.5% vs 20.8%, p < 0.0001). Patients with higher TSB had more side effects overall (p < 0.0001). There was also significant positive correlation with a higher TSB and the overall number of side effects (p < 0.0001). 80% of AD and 90% of asthma patients were satisfied with the counseling. The EHR in AD and asthma resulted in counseling in 89% and 93% respectively and real-time intervention in 27.8% and 3% respectively. Although patients with side effects had more dose adjustments, those without side effects also warranted adjustments. Physician surveys demonstrated improved satisfaction with the EHR tool over time, and minimal impact on visit time. Conclusion: The utilization of our EHR monitoring tool allows for the identification and tracking of TSB in patients, associated side effects and leads to real-time physician intervention.

POSA20 Project Hercules - Burden of Steroid Use in the Treatment of Duchenne Muscular Dystrophy: Findings from a Targeted Literature Review and Online Survey

POSA20 Project Hercules - Burden of Steroid Use in the Treatment of Duchenne Muscular Dystrophy: Findings from a Targeted Literature Review and Online Survey

Ефективність та безпечність терапії пацієнтів з бронхіальною астмою з використанням єдиного інгалятора

Abstract. Selection of adequate therapy for bronchial asthma (BA) by a doctor directly affects not only the level of control over the patient’s symptoms, his compliance, but also improves the patient’s quality of life and avoids his disability. Doctors and patients are already accustomed to the fact that inhaled glucocorticosteroids (ICS) are the most effective anti-inflammatory drugs for the treatment of asthma. However, the response to ICS varies among patients, so some may require a medium-dose ICS if their asthma is not controlled or if they have asthma exacerbations. Among the existing following fixed combinations of ICS/ long-acting β2 -agonists (LABA), which are approved for regular use from the 3rd step of BA treatment, only two are currently available in Ukraine — budesonide + formoterol and fluticasone propionate + salmeterol. GINA recommends the use of an ICS/formoterol combination as the preferred single maintenance and palliative therapy because studies have shown that use of this therapy as a patient-initiated symptomatic palliative therapy when symptoms worsen provides comparable benefit to short-acting β2 -agonists (SABA) for the relief of smooth muscle dysfunction. in addition to providing corticosteroids with an increase in local protection in case of increased inflammation of the respiratory tract Budesonide/formoterol fixed-dose single-inhaler therapy for basic therapy and symptom relief helps achieve the main goals of AD treatment, namely achieving symptom control and reducing future risks, fully consistent with the latest GINA guidelines. This regimen, in comparison with alternative regimens of therapy with fixed doses of other combined drugs and SABA as needed, reduces the risk of exacerbations, gives a lower steroid burden on the patient with a comparable level of BA control.

S2391 Concomitant Treatment of Secondary Lymphocytic Hypophysitis and Crohn’s Disease With Adalimumab

S2391 Concomitant Treatment of Secondary Lymphocytic Hypophysitis and Crohn’s Disease With Adalimumab

Real-World Effectiveness of Anti–IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization

Real-World Effectiveness of Anti–IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization

Absence of Iodinated Contrast Hypersensitivity and Characterization of Gadolinium Utilization in an Interventional Pain Population.

Iodinated contrast media (ICM) allergy labels pose a unique clinical problem for the interventional pain physician due to the drawbacks of gadolinium for enhancement during pain procedures, as well as the reluctance to add to the cumulative steroid burden with steroid premedication. However, the risks of ICM hypersensitivity specific to this setting have not been previously described. We aimed to describe the incidence of ICM-induced hypersensitivity during the performance of epidural injections in a large healthcare system. We also sought to characterize preexisting ICM allergy labels and how these affected consequent gadolinium utilizations in this population. 6,471 epidural pain procedures requiring contrast enhancement were performed during the 18-month study period. There were no reported contrast-induced hypersensitivity reactions in this time. 108 patients (1.6%) had a preexisting ICM allergy; a shellfish/seafood allergy was recorded in 118 patients (1.82%), and 51 charts (0.78%) were labeled with "iodine" allergy. 183 individuals received gadolinium for enhancement during epidural steroid injections. 96.7% of gadolinium utilization occurred in the context of preexisting allergy labels in the electronic medical record. Of note, 20 patients (18.5%) with ICM allergy labels also received iodinated contrast, and this was uneventful in all cases. Our results suggest that ICM-associated hypersensitivity is very rare during epidural procedures and the incidence is significantly lower than expected based on reaction rates during intravascular administration. This may be related to both dose as well as route of administration. The establishment of a protocol for safe workup of ICM allergy labels would be useful in optimizing pain procedures.