Oral Corticosteroid Exposure and Adverse Effects in Asthmatic Patients

To examine the association between intermittent oral corticosteroid (OCS) use and adverse events (AEs) in patients with asthma.

The study included patients with asthma aged ≥18 years. The sample had a mean age of 38 years and was predominantly female (66%). Patients with chronic obstructive pulmonary disease, chronic bronchitis, emphysema, cystic fibrosis, or any of the selected AEs during the baseline period were excluded.

Data were obtained from a retrospective review of an insurance claims data set (MarketScan Claims Database) from January 2000 to June 2014. The number of OCS prescriptions was reviewed. Patients were grouped into an OCS cohort and a no OCS cohort (no OCS prescription in the 12 months before baseline or during study follow-up). AEs were determined by International Classification of Diseases, Ninth Revision codes (osteoporosis, hypertension, diabetes, metabolic syndrome, dyslipidemia, obesity, cataracts, glaucoma, gastrointestinal bleeds and/or ulcers, tuberculosis, depression, herpes, and sepsis). Propensity matching was used to pair each patient in the OCS group with a similar patient in the control group. A regression analysis was used to compare the incidence of AEs between the OCS cohort and the no OCS cohort.

Before matching, there were 72 063 and 156 373 subjects in the OCS and no OCS cohorts, respectively. Subjects taking 1 to 3 or ≥4 OCS prescriptions within the year had increased odds of a new AE within the year (odds ratio: 1.04 and 1.29, respectively). Each year of exposure to ≥4 OCS prescriptions resulted in 1.20 times the odds of having an AE in the current year. Exposure to ≥4 OCS prescriptions in the current year was associated with a statistically significant increased odds (odds ratio of 1.21 to 1.44) of osteoporosis, hypertension, obesity, type 2 diabetes, gastrointestinal ulcers and/or bleeds, fractures, and cataracts.

The authors of this study found that the use of OCSs in patients with asthma was associated with greater odds of having an AE and that the number of prescriptions, regardless of dose or duration, was strongly associated with AEs.

This study is a large retrospective data review of OCS prescriptions in patients with asthma. With this study, the authors suggest that OCS prescriptions have a cumulative impact on long-term health. This study reveals the importance of judicious use of OCSs, including consideration of alternative treatments when possible. The study was limited by reliance on claims data, which may have led to underreporting of AEs. It is also not possible to know if an OCS was actually taken or if a prescription was used for multiple exacerbations.