Oral Corticosteroid Exposure and Adverse Effects in Asthma

Publication date: Available online 27 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Patrick W. Sullivan, Vahram H. Ghushchyan, Gary Globe, Michael Schatz
BackgroundSignificant adverse effects (AEs) have been associated with continuous exposure to oral corticosteroids (OCS). The potential association with intermittent exposure is unknown.ObjectiveAssess the association between OCS and AEs based on the number of OCS prescriptions.MethodsThis was a retrospective cohort study of asthma patients ≥ 18 years in the 2000-2014 MarketScan® dataset. Propensity Score Matching was used at baseline (12 months prior to index date: first OCS use). Logistic regression was used to examine the association between OCS and new-incident AEs (either combined or individual) controlling for covariates. Follow-up continued for 24 months minimum and 10 years maximum after index.ResultsThere were 72,063 and 156,373 individuals in the OCS and no OCS cohorts, respectively. Individuals taking ≥ 4 OCS (1-3) prescriptions within the year had 1.29 (1.04) times the odds of experiencing a new AE within the year. Each year of exposure to ≥ 4 OCS prescriptions (current and past) resulted in 1.20 times the odds of developing an AE in the current year. Exposure to ≥ four prescriptions was associated with significantly greater odds of AEs for: osteoporosis, hypertension, obesity, type 2 diabetes, gastrointestinal ulcers/bleeds, fractures and cataracts (odds 1.21 – 1.44 depending on the AE).ConclusionWhile previous research has documented the deleterious effect of continuous OCS exposure in severe asthma, our results suggest that each OCS prescription may result in a cumulative burden on current and future health, regardless of dose and duration. OCS sparing strategies are extremely important to improving patient outcomes.

Teaser

While previous research has documented the adverse effects (AEs) of continuous oral corticosteroid (OCS) exposure in asthma, our results suggest that intermittent OCS use consistent with "burst" therapy may also result in adverse effects.


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