Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma
© 2024. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology - 20(2024), 1 vom: 26. März, Seite 25 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Casale, Thomas B [VerfasserIn] |
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| Links: |
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| Themen: |
Asthma |
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| Anmerkungen: |
Date Revised 29.03.2024 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13223-024-00882-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370220404 |
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| 100 | 1 | |a Casale, Thomas B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a BACKGROUND: Systemic corticosteroid (SCS) use remains widespread among patients with severe asthma, despite associated complications | ||
| 520 | |a OBJECTIVE: Evaluate the association between cumulative SCS exposure and SCS-related complications in severe asthma | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a CONCLUSION: SCS use, even at low doses, is associated with increased risk of SCS-related complications among patients with severe asthma | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Asthma | |
| 650 | 4 | |a Cardiovascular | |
| 650 | 4 | |a Central nervous system | |
| 650 | 4 | |a Endocrine | |
| 650 | 4 | |a Gastrointestinal | |
| 650 | 4 | |a Metabolic | |
| 650 | 4 | |a Ophthalmologic | |
| 650 | 4 | |a Systemic corticosteroid | |
| 650 | 4 | |a Systemic corticosteroid-related complication | |
| 700 | 1 | |a Corbridge, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Germain, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Laliberté, François |e verfasserin |4 aut | |
| 700 | 1 | |a MacKnight, Sean D |e verfasserin |4 aut | |
| 700 | 1 | |a Boudreau, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a Duh, Mei S |e verfasserin |4 aut | |
| 700 | 1 | |a Deb, Arijita |e verfasserin |4 aut | |
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