Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease that can significantly impair quality of life through persistent nasal obstruction, loss of smell, facial pressure, and sleep disturbance. Oral corticosteroids (OCS) are frequently used to manage severe symptoms, but repeated or prolonged exposure carries well-documented risks, including metabolic, cardiovascular, and bone-related adverse effects. Despite this, real-world data on the extent of OCS use in CRSwNP have been limited, particularly in the Canadian setting.
The ACTIONS study aimed to characterise patterns of OCS use in Canadian patients with severe CRSwNP in the two years preceding initiation of biologic therapy, providing a clearer picture of potential overexposure and opportunities for improved disease management.
High Rates of OCS Exposure Before Biologics
Using IQVIA’s Private Drug Plan claims database, researchers conducted a retrospective analysis of 747 patients with inferred CRSwNP who later initiated biologic therapy. Over the 0–24 months before biologic initiation, OCS use was common, with 81.0% of patients having at least one OCS prescription. The median number of OCS claims per patient was three, indicating repeated courses rather than isolated short-term use.
Total cumulative exposure was substantial. Over the 24-month period, the median total OCS dose was 1,020 mg prednisone-equivalent, and 41.5% of patients met criteria for OCS overexposure, defined as at least 1,000 mg annually. These findings suggest that a large proportion of patients are exposed to steroid doses associated with an increased risk of adverse effects before transitioning to biologic therapies.
Prescribing Patterns and High-Risk Groups
OCS prescriptions were most commonly issued by general practitioners, who accounted for 35.9% of prescriptions, followed closely by otolaryngologists at 32.8%. Patients had a median age of 51 years, just over half were male, and nearly half resided in Ontario, reflecting the regional distribution of the dataset.
Notably, OCS use was highest among patients with comorbid severe asthma, a subgroup likely to have greater inflammatory burden and symptom severity. This overlap highlights the complexity of managing type 2 inflammatory diseases and the cumulative steroid exposure that can result when multiple conditions coexist.
Implications for CRSwNP Management
The ACTIONS study underscores a clear pattern of OCS overexposure in patients with severe CRSwNP prior to biologic initiation. The authors suggest that improved awareness among clinicians and patients regarding appropriate OCS use, alongside earlier consideration of biologic therapies, could reduce steroid-related harm. By supporting shared decision-making and timely treatment escalation, these strategies may lead to safer, more effective long-term management of CRSwNP.
Reference
Chan Y et al. Oral corticosteroid overexposure: characterizing oral corticosteroid use in patients with chronic rhinosinusitis with nasal polypS in Canada (ACTIONS) results. Allergy Asthma Clin Immunol. 2025;DOI: 10.1186/s13223-025-00989-w.
