The Predicting Response to Inhaled Corticosteroid Efficacy (PRICE) trial

Background Although guidelines recommend anti-inflammatory therapy for persistent asthma, recent studies suggest that 25% to 35% of patients with asthma may not improve lung function with inhaled corticosteroids. Objective To evaluate potential biomarkers of predicting short-term (6-week) response to inhaled corticosteroid with subsequent evaluation of responders and nonresponders to asthma control over a longer interval (16 additional weeks). Methods Eighty-three subjects with asthma off steroid were enrolled in this multicenter study. Biomarkers and asthma characteristics were evaluated as predictors of inhaled corticosteroid response over a 6-week trial for changes in FEV 1 and methacholine PC 20 . After this, an additional 4-month trial evaluated asthma control. Results Although multiple baseline predictors had significant correlations with improvements for short-term inhaled steroid success, the only strong correlations ( r ≥ ± 0.6) were albuterol reversibility ( r = 0.83; P 1 /forced vital capacity ( r = −0.75; P 1 % predicted ( r = −0.71; P 5% FEV 1 improvement) and nonresponders (≤5%) determined the longer-term need for steroids. For the nonresponders, asthma control remained unchanged whether inhaled corticosteroids were continued or were substituted with a placebo ( P = .99). The good short-term responders maintained asthma control longer-term only if maintained on inhaled steroids ( P = .007). Conclusion The short-term response to inhaled corticosteroids with regard to FEV 1 improvement predicts long-term asthma control. Clinical implications The decision to use long-term inhaled steroids could be based on a short-term trial. Different therapeutic strategies would need to be established for nonresponders.