Despite Risks, Long-Term Oral Corticosteroid Use Still Common in Asthma

NEW ORLEANS — Despite the potential for adverse events, long-term use of oral corticosteroid medications is common among patients with poor asthma control, according to data presented at the 2019 CHEST Annual Meeting, held October 19 to 23, 2019, in New Orleans, Louisiana.

Researchers sought to estimate the prevalence of oral corticosteroid use and treatment patterns in patients with poor asthma control. Additionally, they aimed to describe the characteristics of US patients with persistent asthma by oral corticosteroid use status.

Patients were identified via the IBM MarketScan Commercial Claims and Encounters, Medicare Supplemental, and Medicaid Multistate Claims research databases. Included patients were ≥12 years old, met 2-year Healthcare Effectiveness Data in Information Set criteria for persistent asthma, and were enrolled in their insurance plans for ≥6 months before and ≥24 months after the index date.

In total, 435,675 patients with persistent asthma were identified. At baseline, patients who were oral corticosteroid users — especially long-term oral corticosteroid users — were older and more likely to be women with commercial insurance, have a history of exacerbations, have greater asthma severity, and have more comorbidities compared with nonusers.

Within the study cohort, 19% of patients were classified as long-term oral corticosteroid users; 46% were non–long-term oral corticosteroid users, and 35% were nonusers. The annual prevalence of long-term oral corticosteroid use was 3.6% in 2013 and grew to 5.4% in 2017.

Overall, nearly two-thirds of oral corticosteroid prescriptions for both long-term and non-long-term patients at baseline were prescribed by family or general practitioners. The investigators found that 41% and 6% of patients with persistent asthma had ≥1 and ≥4 oral corticosteroid prescriptions within the first year of asthma follow up, respectively, with more frequent use among patients who were between 18 and 64 years of age, had a history of exacerbations, and had greater asthma severity at baseline.

During the follow-up period, average daily oral corticosteroid doses were 2.2 mg in long-term users and 0.3 mg in non–long-term users. The corresponding annual mean numbers of oral corticosteroid prescriptions were 2.2 and 0.8 for long-term and non-long-term users, respectively. Over 3 years, average daily doses demonstrated a trend toward a slow decrease in dosage among long-term users, from 30.7 mg to 26.4 mg.

“[Long-term oral corticosteroid] therapy is not uncommon and is often prescribed by nonspecialists,” the researchers concluded. “Physicians should consider [oral corticosteroid]-sparing therapy when possible.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Tran T, Maclachlan S, Liu J, Chung Y, Rubino A, Ganz M. Oral corticosteroid treatment patterns for US patients with persistent asthma. Presented at: CHEST 2019 Annual Meeting; October 19-23, 2019; New Orleans, LA. Abstract 1586.