Oral corticosteroid exposure and adverse effects in asthmatic patients

Sullivan, Patrick W.; Ghushchyan, Vahram; Globe, Gary; Schätz, Michael

doi:10.1016/j.jaci.2017.04.009

Cited by 233 publications

(222 citation statements)

References 15 publications

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“…Our findings support those of the recent study of Sullivan et al,15 while the high granularity data in the OPCRD and CPRD enabled us to further characterize the association of adverse outcomes with defined SCS exposure (doses) over time using the different exposure measures. We used an incident (new) user study design that allowed us to capture adverse outcomes of interest from the first SCS prescription 24.…”

Section: Discussionsupporting

confidence: 89%

“…There are little data available, however, regarding the onset of SCS-associated adverse outcomes from the time of SCS initiation in a broad asthma population not restricted to those with severe disease. Moreover, additional data are needed to help confirm the relationship between cumulative SCS exposure and these outcomes, and the threshold exposure above which the risk of comorbid disease onset meaningfully increases 5,14,15. Of note, 1 g of SCS is equivalent to four short courses of OCS at the usual doses for treating an asthma exacerbation 12.…”

Section: Introductionmentioning

confidence: 99%

“…Of note, 1 g of SCS is equivalent to four short courses of OCS at the usual doses for treating an asthma exacerbation 12. Existing work suggests that a threshold of four SCS courses per year is associated with adverse consequences in patients with asthma 13,15…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Price¹,

Trudo²,

Voorham³

et al. 2018

JAA

305

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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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Price¹,

Trudo²,

Voorham³

et al. 2018

JAA

305

319

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“…8 The long term adverse effects of chronic oral corticosteroid use, which include weight gain, hypertension, and osteoporosis, are a compelling reason to limit their use and attempt step-down if appropriate. 41 Evidence suggests that patients on long term oral corticosteroid treatment may achieve similar levels of control if they are appropriately dosed on inhaled corticosteroids, 20 42 and such a change would theoretically limit systemic corticosteroid exposure and reduce adverse effects. However, in studies comparing oral corticosteroid with inhaled corticosteroid, adverse effects were reported…”

Section: Summary Of Evidence For Step-down Of Asthma Controller Drugsmentioning

confidence: 99%

Why and how to step down chronic asthma drugs

Gionfriddo

Hagan

Rank

2017

BMJ

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Asthma is a common chronic airways disease. The goal of asthma management is to control symptoms while minimizing the side effects of treatment. Following a period of stable asthma, clinicians should consider stepping down treatment. This approach is recommended by current guidelines. Step-down has been studied for several types of asthma drug regimens, and certain approaches may have lower risk than others. Systematic reviews of multiple trials support the following specific step-down approaches: optimizing inhaled corticosteroid dosing when stepping down oral corticosteroid, reducing inhaled corticosteroid from a higher dose, lowering inhaled corticosteroid-long acting bronchodilator (ICS-LABA) dose while adding ICS-LABA on-demand, adding leukotriene receptor antagonist (LTRA) while lowering inhaled corticosteroid dose, and using allergen immunotherapy when reducing inhaled corticosteroid from a higher dose. Systematic reviews of multiple trials support an increased risk of asthma exacerbation for patients who completely stop taking inhaled corticosteroid or long acting bronchodilator. Strategies to implement step-down in practice include the use of risk prediction as well as tools to support shared decision making and communication about risk between clinicians and patients.

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“…Consequently, oral and/or inhalative corticosteroids (CS) represent the standard treatment option for asthma patients since the 1960s [3]. Unfortunately, CS produce considerable side effects with increasing doses and especially when delivered systemically, and patients with low eosinophil counts are less responsive to CS treatment [4]. Thus, over the last two decades, asthma research concentrated on elucidating the mechanisms underlying the initiation, progression, and chronification of airway inflammation in order to unravel novel targets for therapeutic intervention.…”

mentioning

confidence: 99%

Targeting cytokines in asthma therapy: could IL-37 be a solution?

Wegmann

2017

Expert Review of Respiratory Medicine

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Oral corticosteroid exposure and adverse effects in asthmatic patients

Cited by 233 publications

References 15 publications

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

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

Why and how to step down chronic asthma drugs

Targeting cytokines in asthma therapy: could IL-37 be a solution?

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