Overuse of Oral Corticosteroids in Asthma Is Often Underdiagnosed and Inadequately Addressed

Meer, Akke-Nynke van der; Jong, Kim de; Ferns, Michiel; Widrich, Christine; Brinke, Anneke ten

doi:10.1016/j.jaip.2022.03.024

Cited by 7 publications

(2 citation statements)

References 34 publications

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“…Similarly, burst and chronic SCS use in this population was linked with significantly higher rates of HCRU due to SCS-related complications, with even low chronic SCS doses associated with more frequent IP and other HCRU visits. These data support existing evidence of the well-documented and wide-reaching adverse effects associated with SCS use by highlighting a dose-dependent increase in the risk of complications among patients with severe asthma who continue to be frequent users of SCS therapy [ 5 – 10 , 29 ]. They also suggest that even low doses of SCS are associated with complications and that complications occur with both maintenance and burst SCS use.…”

Section: Discussionsupporting

confidence: 80%

“…While the cost effectiveness of biologics has been debated [ 25 ], and reductions in exacerbations requiring hospitalization are the primary driver of cost effectiveness with biologic therapy [ 26 , 27 ], chronic OCS reduction has also been reported to contribute to the lifetime discounted cost effectiveness of biologic therapy [ 28 ]. Despite the introduction of biologics in several countries worldwide, evidence suggests that patients remain unnecessarily reliant on OCS for the management of asthma [ 29 ]. Currently, there are limited data available on the association between cumulative SCS exposure and related complications since the introduction of biologic therapies; therefore, updated assessments are needed.…”

Section: Introductionmentioning

confidence: 99%

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Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma

Casale,

Corbridge,

Germain

et al. 2024

Allergy Asthma Clin Immunol

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Background Systemic corticosteroid (SCS) use remains widespread among patients with severe asthma, despite associated complications. Objective Evaluate the association between cumulative SCS exposure and SCS-related complications in severe asthma. Methods This retrospective, longitudinal study used claims data from the Optum Clinformatics Data Mart database (GSK ID: 214469). Eligible patients (≥ 12 years old) had an asthma diagnosis and were divided into two cohorts: SCS use and non/burst-SCS use. Patients in the SCS use cohort had a claim for a daily prednisone-equivalent dose ≥ 5 mg SCS following ≥ 6 months of continuous SCS use; those in the non/burst-SCS cohort had no evidence of continuous SCS use and had a non-SCS controller/rescue medication initiation claim. For each cohort, the date of the qualifying claim was the index date. SCS users were further stratified by SCS use during each quarter of follow-up: low (≤ 6 mg/day), medium (> 6–12 mg/day), high (> 12 mg/day), and continuous high (≥ 20 mg/day for 90 days). SCS-related complications were evaluated in the quarter following SCS exposure. The adjusted odds ratios (OR) of experiencing SCS-related complications during follow-up in each of the SCS use groups versus the non/burst SCS cohort were calculated using generalized estimating equations models. Results SCS and non/burst-SCS use cohorts included 7473 and 89,281 patients (mean follow-up: 24.6 and 24.2 months), respectively. Compared with the non/burst-SCS use cohort, medium, high, and continuous high SCS use was associated with greater odds of any SCS-related complication (adjusted OR [95% confidence interval]: 1.30 [1.21, 1.39], 1.49 [1.35, 1.64] and 1.63 [1.40, 1.89], respectively) including increased acute gastrointestinal, cardiovascular, and immune system-related complications, and chronic cardiovascular, metabolic/endocrine, central nervous system, bone-/muscle-related, ophthalmologic, and hematologic/oncologic complications. Low-dose SCS use was also associated with significantly increased odds of acute gastrointestinal and immune system-related complications, and chronic bone-/muscle-related and hematologic/oncologic complications versus the non/burst-SCS use cohort. Conclusion SCS use, even at low doses, is associated with increased risk of SCS-related complications among patients with severe asthma.

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Section: Discussionsupporting

confidence: 80%