Atopic Eczema–Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study

Matthewman, Julian; Mansfield, Kathryn E.; Prieto‐Alhambra, Daniel; Mulick, Amy; Smeeth, Liam; Lowe, Katherine; Silverwood, Richard; Langan, Sinéad

doi:10.1016/j.jaip.2021.09.026

Cited by 8 publications

(4 citation statements)

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“…Results from adjusted analyses showed somewhat attenuated HRs. A possible explanation is that some inflammatory diseases of interest may be associated with increased fracture risk independent of oral corticosteroids . Eczema, asthma, and COPD are treated with topical and inhaled corticosteroids, respectively, but it is controversial whether they are associated with clinically meaningful fracture risk .…”

Section: Discussionmentioning

confidence: 99%

“…A possible explanation is that some inflammatory diseases of interest may be associated with increased fracture risk independent of oral corticosteroids. 27 Eczema, asthma, and COPD are treated with topical and inhaled corticosteroids, respectively, but it is controversial whether they are associated with clinically meaningful fracture risk. 28 , 29 Null effects observed for all negative control outcomes suggest that there were no major sources of bias.…”

Section: Discussionmentioning

confidence: 99%

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Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario

et al. 2023

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ImportanceIdentifying and mitigating modifiable gaps in fracture preventive care for people with relapsing-remitting conditions such as eczema, asthma, and chronic obstructive pulmonary disease who are prescribed high cumulative oral corticosteroid doses may decrease fracture-associated morbidity and mortality.ObjectiveTo estimate the association between different oral corticosteroid prescribing patterns and appropriate fracture preventive care, including treatment with fracture preventive care medications, among older adults with high cumulative oral corticosteroid exposure.Design, Setting, and ParticipantsThis cohort study included 65 195 participants with UK electronic medical record data from the Clinical Practice Research Datalink (January 2, 1998, to January 31, 2020) and 28 674 participants with Ontario, Canada, health administrative data from ICES (April 1, 2002, to September 30, 2020). Participants were adults 66 years or older with eczema, asthma, or chronic obstructive pulmonary disease receiving prescriptions for oral corticosteroids with cumulative prednisolone equivalent doses of 450 mg or higher within 6 months. Data were analyzed October 22, 2020, to September 6, 2022.ExposuresParticipants with prescriptions crossing the 450-mg cumulative oral corticosteroid threshold in less than 90 days were classified as having high-intensity prescriptions, and participants crossing the threshold in 90 days or more as having low-intensity prescriptions. Multiple alternative exposure definitions were used in sensitivity analyses.Main Outcomes and MeasuresThe primary outcome was prescribed fracture preventive care. A secondary outcome was major osteoporotic fracture. Individuals were followed up from the date they crossed the cumulative oral corticosteroid threshold until their outcome or the end of follow-up (up to 1 year after index date). Rates were calculated for fracture preventive care and fractures, and hazard ratios (HRs) were estimated from Cox proportional hazards regression models comparing high- vs low-intensity oral corticosteroid prescriptions.ResultsIn both the UK cohort of 65 195 participants (mean [IQR] age, 75 [71-81] years; 32 981 [50.6%] male) and the Ontario cohort of 28 674 participants (mean [IQR] age, 73 [69-79] years; 17 071 [59.5%] male), individuals with high-intensity oral corticosteroid prescriptions had substantially higher rates of fracture preventive care than individuals with low-intensity prescriptions (UK: 134 vs 57 per 1000 person-years; crude HR, 2.34; 95% CI, 2.19-2.51, and Ontario: 73 vs 48 per 1000 person-years; crude HR, 1.49; 95% CI, 1.29-1.72). People with high- and low-intensity oral corticosteroid prescriptions had similar rates of major osteoporotic fractures (UK: crude rates, 14 vs 13 per 1000 person-years; crude HR, 1.07; 95% CI, 0.98-1.15 and Ontario: crude rates, 20 vs 23 per 1000 person-years; crude HR, 0.87; 95% CI, 0.79-0.96). Results from sensitivity analyses suggested that reaching a high cumulative oral corticosteroid dose within a shorter time, with fewer prescriptions, or with fewer or shorter gaps between prescriptions, increased fracture preventive care prescribing.ConclusionsThe results of this cohort study suggest that older adults prescribed high cumulative oral corticosteroids across multiple prescriptions, or with many or long gaps between prescriptions, may be missing opportunities for fracture preventive care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario

et al. 2023

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“…We used morbidity code lists used in previous electronic health record research developed with input from UK-practicing clinicians (for more detail see Appendix Section "Codelists", Supplementary Table 2). 4,21,[24][25][26] All data management and statistical analysis code is available on GitHub (repository to be published together with manuscript).…”

Section: Exposure and Outcome Measurementmentioning

confidence: 99%

Anxiety and Depression in People with Eczema or Psoriasis: A Comparison of Associations in UK Biobank and Linked Primary Care Data

Matthewman,

Mansfield,

Hayes

et al. 2023

CLEP

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Introduction Previous research has shown associations between eczema and psoriasis and anxiety and depression. We investigated whether associations are consistent across different settings of ascertainment for depression and anxiety, including interview and survey responses from UK Biobank (a large longitudinal cohort recruiting individuals aged 40–69 years between 2006–2010), and linked primary care data, with the aim of drawing more reliable conclusions through triangulation. Methods In cross-sectional studies, we estimated associations between eczema or psoriasis and anxiety or depression, defining anxiety or depression as 1) self-reported previous diagnosis at UK Biobank recruitment interview; 2) PHQ-9/GAD-7 score indicating depression or anxiety from a UK Biobank mental health follow-up survey in 2016; and 3) diagnosis in linked primary care electronic health record data. Results We analysed 230,047 people with linked Biobank and primary care data. We found poor agreement between the data sources for eczema, psoriasis, anxiety, and depression. Eg, 9474 had a previous eczema diagnosis in primary care data, 4069 self-reported previous eczema diagnosis at the UK biobank interview, and 1536 had eczema in both data sources (for depression 40,455; 13,320; and 9588 respectively). Having eczema or psoriasis (recorded in primary care or baseline interview) was associated with higher odds of anxiety and depression. Eg, the adjusted odds ratio for depression comparing those with eczema to those without was greater than 1 when defining the outcome from 1) the recruitment interview (1.36, 95% confidence interval 1.27–1.45); 2) the follow-up survey (1.24, 1.09–1.39), and 3) primary care records (1.56, 1.50–1.62). Discussion Our findings support increased prevalence of mental illness in people with psoriasis and eczema across multiple data sources, which should be considered in planning of mental health services. However, we found poor agreement in disease ascertainment between settings, with implications for data interpretation in electronic health records.

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“…Glucocorticoids directly applied to the affected part of the skin remain the backbone of AD management over the previous 60 years [56][57][58]. Hydrocortisone was identified as the initial steroid cast-off in AD [56][57][58].…”

Section: Glucocorticoid In Atopic Dermatitismentioning

confidence: 99%

Management of Atopic Dermatitis: The Role of Tacrolimus

Umar¹,

Rahman²,

Dutta³

et al. 2022

Cureus

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Atopic dermatitis (AD) is a long-lasting inflammatory dermatological condition characterized by itchy, eczematous, sparsely tiny blisters that hold a clear watery substance. Additionally, the diseased skin can suppurate, occasionally with weeping with thickening of the affected skin. This is considered one of the top skin disorders involving both children and adult populations globally. The principal therapeutic intervention for AD is long-standing topical glucocorticoids, which have been used for several decades. Corticosteroid therapy brings several adverse drug effects (ADRs), including irreversible skin atrophy. Tacrolimus belongs to the class of calcineurin inhibitors, which is a type of immunomodulator possessing promising efficacy in treating AD. Topical tacrolimus is an effective and safe non-corticosteroid substitute treatment for AD. We reviewed the available literature to compare and institute the safety, efficacy, and effectiveness of tacrolimus when equated to corticosteroid therapy in managing AD.

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Atopic Eczema–Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study

Cited by 8 publications

References 65 publications

Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario

Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario

Anxiety and Depression in People with Eczema or Psoriasis: A Comparison of Associations in UK Biobank and Linked Primary Care Data

Management of Atopic Dermatitis: The Role of Tacrolimus

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