Patients who are prescribed intermittent oral corticosteroids (OCS) for asthma with increasing frequency have a higher risk of OCS-related adverse outcomes (AO), according to study findings published in Thorax.
Investigators sought to evaluate the association over time between patterns of intermittent OCS prescriptions, cumulative OCS dosages, and OCS-related adverse outcomes in patients with asthma treated with intermittent-only OCS.
The researchers conducted a retrospective cohort study of almost half a million patients with asthma in the UK at least 4 years of age, using electronic medical records data from the Optimum Patient Care Research Database and the Clinical Practice Research Datalink GOLD from 2008 to 2019. All patients included for analysis received only intermittent OCS. Patients were stratified according to the frequency of their OCS prescriptions, as indexed on their first intermittent OCS prescription for asthma, into 3 groups: (1) one-time; (2) less frequent (≥90-day gap); and (3) frequent (<90-day gap).
Investigators matched patients taking intermittent OCS with a control group of patients not taking OCS. Participants were matched 1:1 for sex (56% women), age (16% 4-11 years of age; 8% 12-17 years of age; 62% 18-64 years of age, 15% ≥65 years of age), and index date (time in database pre-index, median 17 years). The researchers used a multivariable Cox-proportional hazard model to assess associations between the OCS prescribing patterns and OCS-related AO risk (stratified by age), Global Initiative for Asthma (GINA) 2020 treatment step, and pre-index inhaled corticosteroid (ICS) and short-acting β2-agonist (SABA) prescriptions. Median follow-up duration was 8.3 years (interquartile range [IQR], 4.2-13.7 years). The mean cumulative OCS dose was 176 mg (IQR, 150-200) for the one-time group, 510 mg (IQR, 300-600) for the less frequent group, and 2357 mg (IQR, 540-1800) for the frequent group.
Among the 476,167 asthma patients studied, investigators found 41.7% experienced one-time intermittent OCS prescribing patterns, 26.8% experienced less frequent, and 31.6% experienced frequent OCS prescribing patterns. Patients who received more frequent intermittent OCS prescriptions were older and more likely to be women. Increasing frequency of intermittent OCS prescriptions was associated with increased risk of any AO compared with non-use of OCS (one-time hazard ratio [HR], 1.19; 95% CI, 1.18-1.20), (less frequent HR, 1.35; 95% CI, 1.34-1.36), (frequent HR, 1.42; 95% CI, 1.42-1.43) and remained consistent across subgroups of age, GINA treatment step, and ICS and SABA.
The AOs most highly correlated with increasing frequency of OCS prescriptions were sleep apnea and pneumonia. Compared with the non-OCS group, increased risk for all AOs except dyslipidemia were observed at dosages of 0.5-1.0 g.
Significant study limitations include misclassification of intermittent and long-term OCS prescriptions; the possibility of missing data and confounding factors because patient records were not assessed for validity or completeness; residual confounding; and the likelihood of incomplete analysis of AOs among children.
“A considerable proportion of patients with asthma who are prescribed OCS intermittently have a frequent pattern of use at some point. Increasingly frequent prescribing patterns of intermittent OCS were associated with a higher risk of individual OCS-related adverse outcomes, and this association remained consistent across levels of age, GINA treatment step, and ICS maintenance and SABA reliever use,” concluded investigators, who stressed the importance of minimizing intermittent OCS use.
Disclosure: This research was supported by AstraZeneca. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.