The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

Daugherty, Jonas; Lin, Xiwu; Baxter, Richard; Suruki, Robert; Bradford, Eric

doi:10.1080/02770903.2017.1353612

Cited by 39 publications

(36 citation statements)

References 26 publications

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“…We followed patients from the time of SCS initiation until the time they experienced an event or were otherwise censored. 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%

“…Most prior studies included limited patient populations, ie, those classified as having severe asthma7–9,25 or those prescribed SCS for prespecified lengths of time 26,27. 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.…”

Section: Discussionmentioning

confidence: 99%

“…However, the concern with maintenance SCS use is increased risk of infections and cardiovascular events; of chronic conditions such as type 2 diabetes mellitus, osteoporosis, and cataracts; of metabolic effects such as weight gain; and of neuropsychiatric effects such as insomnia, depression, and behavioral disturbances 3–5. A dose-response relationship with SCS exposure has been documented for many of these events 6–9. Even short-term use of oral corticosteroids (OCS) in a large population-based study has been associated with increased rates of sepsis, thromboembolism, and fracture within 30 days of OCS initiation 10.…”

Section: Introductionmentioning

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%

See 3 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

301

319

View full text Add to dashboard Cite

show abstract

“…A longitudinal UK study from 2005 to 2012, involving >60 000 patients with severe asthma, found 75% of severe asthma patients were exposed to OCS . During 8 years of follow‐up, the proportion of patients exposed to an average cumulative OCS dose of up to 2.5 mg/day prednisolone equivalent increased with each year of study observation.…”

Section: Usage Prevalence and Burden Of Ocs In Severe Asthmamentioning

confidence: 99%

Rational oral corticosteroid use in adult severe asthma: A narrative review

et al. 2019

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OCS play an important role in the management of asthma. However, steroid-related AE are common and represent a leading cause of morbidity. Limited published studies suggest OCS usage varies across countries and recent registry data indicate that at least 25-60% of patients with severe asthma in developed countries may at some stage be prescribed OCS. Recent evidence indicate that many patients do not receive optimal therapy for asthma and are often prescribed maintenance OCS or repeated steroid bursts to treat exacerbations. Given the recent progress in adult severe asthma and new treatment options, judicious appraisal of steroid use is merited. A number of strategies and add-on therapies are now available to treat severe asthma. These include increasing specialist referral for multidisciplinary assessments and implementing OCSsparing interventions, such as improving guideline adherence and add-on tiotropium and macrolides. Biologics have recently become available for severe asthma; these agents reduce asthma exacerbations and lower OCS exposure. Further research, collaboration and consensus are necessary to develop a structured stewardship approach including realistic OCS-weaning programmes for patients with severe asthma on regular OCS; education and public health campaigns to improve timely access to specialized severe asthma services for treatment optimization; and implementing targeted strategies to identify patients who warrant OCS use using objective biomarker-based strategies.

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Efficacy and safety of glucocorticoids for patients with IgA nephropathy: a meta-analysis

Zhang

et al. 2019

Int Urol Nephrol

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The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

Abstract: Most patients with severe asthma are exposed to SGC, which increases SGC-related AE risk. This suggests that SGC exposure should be minimized as recommended by asthma treatment guidelines.

Cited by 39 publications

References 26 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

Rational oral corticosteroid use in adult severe asthma: A narrative review

Efficacy and safety of glucocorticoids for patients with IgA nephropathy: a meta-analysis

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