Risk of Adverse Effects in Asthma Increases With Oral Corticosteroids
Exposure to four or more oral corticosteroid prescriptions significantly increased the odds of osteoporosis
Findings from a study published in the Journal of Allergy and Clinical Immunology suggest that oral corticosteroids, regardless of dose or duration, may increase the risk of adverse effects in patients with severe asthma.
Previous research has shown that continuous oral corticosteroid use has been associated with significant adverse effects, however, little is known on whether intermittent use imparts similar effects. Given that oral corticosteroid use is prevalent in patients with severe asthma, the researchers wanted to get a better understanding of the relationship between these drugs and the likelihood of experiencing an adverse effect.
Using the MarketScan dataset (2000–2014), they conducted a retrospective cohort study in adult asthma patients. Adverse effects were compared between the treatment (n=72,063) and control (n=156,373) groups during the follow-up period (minimum of 24 months and maximum of 10 years after the index date); propensity score matching was used to pair patients in the treatment group with similar patients in the control group, with logistic regression conducted to examine the association.
Compared to the control group, patients who took four or more oral corticosteroid prescriptions had 1.29 times the odds of experiencing a new adverse effect within the year; each year of exposure (both current and past) resulted in 1.20 times the odds of having an adverse effect in the current year. Specifically, exposure to four or more oral corticosteroid prescriptions significantly increased the odds of osteoporosis, type 2 diabetes, hypertension, obesity, GI ulcers/bleeds, fractures and cataracts; the odds ratios for these adverse effects ranged from 1.21–1.44.
"It appears that the number of prescriptions dispensed within a year is strongly associated with [adverse effects], irrespective of dose and duration," say the authors, "The results highlight the importance of maintaining asthma control and may support the notion that the use of [oral corticosteroid] 'bursts' is deleterious to patient health even if they are short-term, particularly if the patient requires more than four per year." In addition, the authors note that the research suggests that each year of exposure may increase the likelihood of developing adverse effects as well.
Sullivan PW, Ghuschchyan VH, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthma [published online April 26, 2017]. J Allergy Clin Immunol. doi: 10.1016/j.jaci.2017.04.009.