Burden of systemic glucocorticoid-related complications in severe asthma

Lefèbvre, Patrick; Duh, Mei Sheng; Lafeuille, Marie-Hélène; Gozalo, Laurence; Desai, Urvi; Robitaille, Marie-Noëlle; Albers, Frank C.; Yancey, Steve; Ortega, Héctor; Forshag, Mark; Lin, Xiwu; Dalal, Anand A.

doi:10.1080/03007995.2016.1233101

Cited by 64 publications

(68 citation statements)

References 27 publications

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“…The mean annual cost for the regular OCS group was €5615, which was three times greater than for the non-OCS group, supporting already available data on the increased health care cost associated with OCS use [27] and poorly controlled asthma [7]. Indirect costs could not be captured in our study.…”

Section: Discussionsupporting

confidence: 76%

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

et al. 2018

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BackgroundPatients with severe uncontrolled asthma may receive oral corticosteroid (OCS) treatment regularly. The present study investigated the health care resource utilization and cost in regularly OCS treated Swedish asthma patients.Methods Primary care medical records data were linked to data from Swedish national health registries. Patients ≥18 years with a drug claim for obstructive pulmonary diseases during 2007–2009 (index date) and a prior asthma diagnosis, were classified by their OCS claims during the 12-months’ post index period: regular OCS equals ≥5 mg per day; periodic OCS less than 5 mg per day; or non-OCS users. Cost of asthma- and OCS-morbidity-related health care resource utilization were calculated.ResultsA total of 15,437 asthma patients (mean age 47.8, female 62.6%), whereof 223 (1.44%) were regular OCS users, 3054 (19.7%) were periodic, and 12,160 (78.7%) were non-OCS users. Regular OCS users were older and more often females, had lower lung function, greater eosinophil count and more co-morbidities at baseline compared with the other groups. Age-adjusted annual total health care cost was three-times greater in the regular OCS group (€5615) compared with the non-OCS users (€1980) and twice as high as in the periodic OCS group (€2948). The major cost driver in the non-OCS and periodic OCS groups were primary care consultations, whereas inpatient costs were the major cost driver in the regular OCS group. The asthma related costs represented 10–12% of the total cost in all three groups.ConclusionIn this real-life asthma study in Sweden, the total yearly cost of health care resource utilization for a regular OCS user was three times greater than for a patient with no OCS use, indicating substantial economic and health care burden for asthma patients on regular oral steroid treatment.

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Section: Discussionsupporting

confidence: 76%

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

et al. 2018

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“…The use of large UK databases containing longitudinal medical record data allowed us to examine a median of almost 10 years before the first SCS prescription to exclude prior SCS use, with subsequent follow-up of a median of 7 years, much longer than prior studies in asthma with reported mean and median follow-up periods of 1–5 years 7–9,15,25. Moreover, earlier studies examined effects of ongoing (rather than initiating) SCS exposure7,8,25–27 or ruled out previous exposure for only ≤12 months before the index prescription 9,15…”

Section: Discussionmentioning

confidence: 99%

“…Studies from the USA included low-income7,8 or employed15,25–28 populations, selective populations with limited or better-than-average access to care, respectively. Instead, the majority of people in the UK are registered with GPs, who administer primary care and serve as the gate-keeper for secondary care; thus, the CPRD and OPCRD include data from a broad, representative patient population, supporting the generalizability of our findings.…”

Section: Discussionmentioning

confidence: 99%

“…An increased risk of adverse outcomes associated with regular SCS exposure has been recorded in severe asthma populations 8,9. In a recent cross-sectional, on-treatment study in the UK,13 93% of patients with severe asthma had one or more conditions linked to SCS exposure, including type 2 diabetes, osteoporosis, dyspeptic disorders (gastric/duodenal ulcers), and cataracts.…”

Section: Introductionmentioning

confidence: 99%

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Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study

Price¹,

Trudo²,

Voorham³

et al. 2018

JAA

301

319

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PurposePrior work suggests a threshold of four courses/year of systemic corticosteroid (SCS) therapy is associated with adverse consequences. The objective of this study was to investigate the onset of adverse outcomes beginning at SCS initiation in a broad asthma population.Patients and methodsThis historical matched cohort study utilized anonymized, longitudinal medical record data (1984–2017) of patients (≥18 years) with active asthma. Matched patients with first SCS prescription (SCS arm) and no SCS exposure (non-SCS arm) were followed until first outcome event. Associations between time-varying exposure measures and onset of 17 SCS-associated adverse outcomes were estimated using Cox proportional hazard regression, adjusting for confounders, in separate models.ResultsWe matched 24,117 pairs of patients with median record availability before SCS initiation of 9.9 and 8.7 years and median follow-up 7.4 and 6.4 years in SCS and non-SCS arms, respectively. Compared with patients in the non-SCS arm, patients prescribed SCS had significantly increased risk of osteoporosis/osteoporotic fracture (adjusted hazard ratio 3.11; 95% CI 1.87–5.19), pneumonia (2.68; 2.30–3.11), cardio-/cerebrovascular diseases (1.53; 1.36–1.72), cataract (1.50; 1.31–1.73), sleep apnea (1.40; 1.04–1.86), renal impairment (1.36; 1.26–1.47), depression/anxiety (1.31; 1.21–1.41), type 2 diabetes (1.26; 1.15–1.37), and weight gain (1.14; 1.10–1.18). A dose-response relationship for cumulative SCS exposure with most adverse outcomes began at cumulative exposures of 1.0–<2.5 g and for some outcomes at cumulative exposures of only 0.5–<1 g (vs >0–<0.5 g reference), equivalent to four lifetime SCS courses.ConclusionOur findings suggest urgent need for reappraisal of when patients need specialist care and consideration of nonsteroid therapy.

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“…16 Overall, complications related to OCS amounted to an estimated annual health care cost differential of up to $8,560 among OCS users vs nonusers. 17 Effective OCS-sparing therapies are needed for patients with severe asthma.…”

Section: Complications Of Ocs Usementioning

confidence: 99%

Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

Blaiss

Castro

Chipps

et al. 2017

Annals of Allergy, Asthma & Immunology

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Burden of systemic glucocorticoid-related complications in severe asthma

Abstract: These findings confirm the risk associated with chronic use of SGCs, irrespective of dose level, and highlight the need for new SGC-sparing treatment strategies for patients with severe asthma.

Cited by 64 publications

References 27 publications

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study

Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

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