Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma

Heath Heatley; Trung N Tran; Arnaud Bourdin; Andrew Menzies-Gow; David J Jackson; Ekaterina Maslova; Jatin Chapaneri; Derek Skinner; Victoria Carter; Jeffrey Shi Kai Chan; Con Ariti; John Haughney; David B Price

doi:10.1136/thorax-2022-219642

Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma

Thorax. 2023 Sep;78(9):860-867. doi: 10.1136/thorax-2022-219642. Epub 2022 Dec 27.

Authors

Affiliations

¹ Observational and Pragmatic Research Institute, Singapore.
² BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA.
³ Department of Respiratory Diseases, PhyMedExp, University of Montpellier, Montpellier, France.
⁴ UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals and School of Immunology & Microbial Sciences, King's College, London, UK.
⁵ UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College, London, UK.
⁶ BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
⁷ NHS Clinical Research Facilities, Glasgow, UK.
⁸ Observational and Pragmatic Research Institute, Singapore dprice@opri.sg.
⁹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Abstract

Introduction: Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (adverse outcomes); no previous study has focused exclusively on intermittent OCS use.

Methods: This historical (2008-2019) UK cohort study using primary care medical records from two anonymised, real-life databases (OPCRD and CPRD) included patients aged≥4 years with asthma receiving only intermittent OCS. Patients were indexed on their first recorded intermittent OCS prescription for asthma and categorised by OCS prescribing patterns: one-off (single), less frequent (≥90 day gap) and frequent (<90 day gap). Non-OCS patients matched 1:1 on gender, age and index date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, Global Initiative for Asthma (GINA) 2020 treatment step, and pre index inhaled corticosteroid (ICS) and short-acting β₂-agonist (SABA) prescriptions using a multivariable Cox-proportional hazard model.

Findings: Of 476 167 eligible patients, 41.7%, 26.8% and 31.6% had one-off, less frequent and frequent intermittent OCS prescribing patterns, respectively. Risk of any AO increased with increasingly frequent patterns of intermittent OCS versus non-OCS (HR; 95% CI: one-off 1.19 (1.18 to 1.20), less frequent 1.35 (1.34 to 1.36), frequent 1.42 (1.42 to 1.43)), and was consistent across age, GINA treatment step and ICS and SABA subgroups. The highest risks of individual OCS-related adverse outcomes with increasingly frequent OCS were for pneumonia and sleep apnoea.

Conclusion: A considerable proportion of patients with asthma receiving intermittent OCS experienced a frequent prescribing pattern. Increasingly frequent OCS prescribing patterns were associated with higher risk of OCS-related adverse outcomes. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.

Keywords: Asthma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Inhalation
Adrenal Cortex Hormones / adverse effects
Anti-Asthmatic Agents* / adverse effects
Asthma* / drug therapy
Cohort Studies
Humans
United Kingdom / epidemiology

Substances

Anti-Asthmatic Agents
Adrenal Cortex Hormones