A 2-week oral prednisolone intervention improved lung function in severe asthma (FEV1 2.28 L post vs 2.04 L pre, p<0.05) and significantly reduced serum periostin levels (p<0.0001).
RCT (n=151)
Double-blind
Do T H 2 specific biomarkers (periostin, eosinophils, exhaled NO) determine responsiveness to oral prednisolone in patients with severe asthma?
Serum periostin levels, eosinophilic inflammation, and exhaled NO are associated with responsiveness to oral corticosteroid treatment in severe asthma, and periostin levels are sensitive to this treatment.
Absolute Event Rate: 2.28% vs 2.04%
p-value: p=<0.05
Biomarkers able to determine responsiveness to therapy in severe asthma (SA) are needed. Our goal was to examine the usefulness of periostin, eosinophils and exhaled NO as potential T H 2 specific markers of glucocorticoid responsiveness in SA. Following a 4 week treatment optimization period, patients with SA (n=85) and mild-to-moderate asthma (MA) (n=66) underwent a 2 wk double-blind placebo controlled oral prednisolone (0.5 mg/kg BW daily) intervention (OPI). Serum periostin levels were measured by ELISA using 2 rat anti-human periostin mAbs (clones SS18A 37:1119). The OPI improved lung function in SA (FEV 1 : 2.28±0.13 L post vs 2.04±0.12 L pre, p<0.05, mean ± SEM) but not in MA. Baseline periostin levels were no different between MA and SA patients (84 vs 84 ng/ml, p=0.711), although higher periostin levels tended to associate with response to OPI (non-responders 82, vs responders 97 ng/ml, p=0.068). Steroid treatment caused a significant reduction in periostin (82 vs 68 ng/ml, p<0.0001). SA patients with the highest exhaled NO, and blood/sputum eosinophils, showed a larger improvement in FEV1% after the OPI compared to those with low levels of studied biomarkers (p<0.05). Dividing patients into high and low periostin groups revealed that patients with high periostin levels also had higher sputum and blood eosinophils (p=0.027, p=0.0002 respectively), lower BMI (p=0.014), higher exhaled NO (p=0.037) and higher total IgE (p=0.020). Our findings confirm associations between serum periostin levels, eosinophilic inflammation and responsiveness to corticosteroid treatment. Furthermore, we demonstrate that levels of serum periostin are sensitive to oral steroid treatment.
James et al. (Sun,) conducted a rct in Severe asthma and mild-to-moderate asthma (n=151). Oral prednisolone vs. Placebo was evaluated on Lung function (FEV1) in severe asthma (post vs pre treatment) (p=<0.05). A 2-week oral prednisolone intervention improved lung function in severe asthma (FEV1 2.28 L post vs 2.04 L pre, p<0.05) and significantly reduced serum periostin levels (p<0.0001).