Recognising the long-term burden of short course oral corticosteroids

Heaney, Liam G.; Schleich, Florence; Korn, Stephanie; Howarth, Peter; Antoun, Zeina; Bourdin, Arnaud; Canonica, Giorgio Walter

doi:10.1183/13993003.congress-2021.pa3548

Cited by 2 publications

(4 citation statements)

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“…Further, a recent literature review reported short-term use of OCS was associated with risk from serious AEs, including osteoporosis, hyperglycemia, and muscle weakness. 15 As the results of the sensitivity analysis for patients with no reduction in OCS dose were similar to the overall cohort, it is likely that the pre-versus post-index changes in potential OCS-related AEs were attributable to continued use of OCS, rather than another factor. Fewer patients had an all-cause or COPD-related inpatient admission, ER visit, or outpatient office visit during the post-index period than the pre-index period.…”

mentioning

confidence: 84%

Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

Bogart,

Abbott,

Bangalore

et al. 2023

COPD

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Purpose Oral corticosteroids (OCS) play a role in the treatment of acute chronic obstructive pulmonary disease (COPD) exacerbations; however, chronic use is not recommended due to the high rate of systemic complications, development of comorbidities, and increased mortality. Data assessing the real-world impact of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) on OCS utilization rates are limited. This study assessed the impact of FF/UMEC/VI on OCS use among patients with COPD previously treated with OCS. Patients and Methods A retrospective database study of patients with COPD aged ≥40 years who initiated FF/UMEC/VI from 1 November 2017 to 31 December 2018, identified through the MarketScan ® Commercial and Medicare Supplemental databases. Patients were required to have ≥1 dispensing of an OCS prior to initiation of FF/UMEC/VI (index) and were followed up for 12 months post-index. OCS utilization patterns, potential OCS-related adverse events, healthcare resource utilization (HCRU), and costs were compared between the 12-month pre- and post-index periods. Results A total of 2013 patients were identified (mean age 63.5 years, 55.7% female). The proportion of patients with ≥1 OCS claim decreased by 32.2% between the pre- and post-index period (67.8% vs 100%; p < 0.001). Comparing the post-index period to the pre-index period, mean number of OCS pharmacy claims per patient decreased from 3.3 to 2.5 (p < 0.001) and mean daily dose was reduced from 3.1 to 2.6 mg/day (p = 0.004); 30.0% of patients reduced their daily dose by 90–100%. Reductions were also seen in COPD-related HCRU. The proportion of patients with an inpatient admission for COPD decreased from 11.4% to 7.1% (p < 0.001), emergency room visits decreased from 23.1% to 17.4% (p < 0.001), and office visits from 97.5% to 90.1% (p < 0.001). Similar results were seen for all-cause HCRU. Conclusion Among patients with COPD with prior OCS use, FF/UMEC/VI initiation resulted in significant reductions in OCS utilization, COPD-related HCRU (including hospitalization), and all-cause HCRU.

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confidence: 84%

Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

Bogart,

Abbott,

Bangalore

et al. 2023

COPD

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“…These findings align with recent literature reviews that highlighted a wide range of OCS-related side effects, even with brief exposure to OCS, and these side effects worried patients. 22 , 69 Furthermore, patients had low levels of satisfaction with the information provided by healthcare professionals regarding OCS-related side effects. Overall, these factors contributed to high levels of poor OCS treatment adherence.…”

Section: Ocs-sparing Treatments At the Patient And Physician Levelmentioning

confidence: 99%

“… 23 Increasing OCS exposure has a statistically significant dose-dependent relationship with the risk of developing either acute or chronic OCS-related complications. 14 , 20 , 24 This risk is also present with OCS exposures as low as ⩽1 mg/day, 22 , 25 , 26 with each OCS prescription adding a cumulative burden on current and future health, regardless of dose and duration. 27 This is particularly pertinent for patients with severe asthma as OCS can also be used to treat comorbidities such as chronic rhinosinusitis with nasal polyps; 28 as such, multiple different specialists may be prescribing short-term OCS therapy.…”

Section: Introductionmentioning

confidence: 99%

“…10 Maintenance OCS use is associated with a wide range of well-recognized and serious short-and long-term adverse events (AEs), including weight gain, diabetes, osteoporosis, cataracts, hypertension, and adrenal suppression as well as increased risk of mortality. 2,10,[13][14][15][16][17][18][19][20][21][22] Psychological AEs, such as depression and anxiety, have also been reported by patients on OCS therapy. 23 Increasing OCS exposure has a statistically significant dosedependent relationship with the risk of developing either acute or chronic OCS-related complications.…”

Section: Introductionmentioning

confidence: 99%

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Oral corticosteroid-sparing effects of mepolizumab in severe eosinophilic asthma: evidence from randomized controlled trials and real-world studies

Casale

Burnette

Bourdin

et al. 2022

Ther Adv Respir Dis

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Oral corticosteroids (OCS) have long been a mainstay of treatment for asthma exacerbations and chronic severe asthma. However, it is increasingly recognized that both long-term and short-term OCS use are directly associated with a wide range of serious adverse effects, and as such OCS-sparing treatment alternatives are now widely recommended for patients with severe asthma. While several international guidelines recommend these treatments, guidance on OCS tapering, and which patients are most likely to tolerate OCS reduction and/or discontinuation, is still lacking. Several biologics have demonstrated efficacy in patients with OCS-dependent asthma. One OCS-sparing treatment is the anti-interleukin-5 monoclonal antibody mepolizumab, which is approved for the treatment of severe eosinophilic asthma. In addition to improved exacerbation rates, asthma control, quality of life, and lung function among patients with severe eosinophilic asthma, mepolizumab also has an OCS-sparing effect, which has been demonstrated in randomized controlled trials and real-world studies. Both physicians and patients express concerns about the adverse effects of OCS, and additional data from the randomized, controlled SIRIUS trial (NCT01691508) highlight the high level of concern among patients regarding OCS-related burden. In this article, we discuss current guidance on OCS-sparing strategies for patients with severe asthma, provide a summary of the available evidence of the OCS-sparing effect of mepolizumab, and highlight patient and physician perspectives on the use of OCS and OCS-sparing treatments in severe asthma.

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Recognising the long-term burden of short course oral corticosteroids

Cited by 2 publications

References 0 publications

Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

Oral corticosteroid-sparing effects of mepolizumab in severe eosinophilic asthma: evidence from randomized controlled trials and real-world studies

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