PMID- 23587268
OWN - NLM
STAT- MEDLINE
DCOM- 20131017
LR  - 20220331
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 35
IP  - 4
DP  - 2013 Apr
TI  - Cumulative burden of oral corticosteroid adverse effects and the economic 
      implications of corticosteroid use in patients with systemic lupus erythematosus.
PG  - 486-97
LID - S0149-2918(13)00111-2 [pii]
LID - 10.1016/j.clinthera.2013.03.001 [doi]
AB  - BACKGROUND: Corticosteroids (CSs) are used to treat patients with systemic lupus 
      erythematosus (SLE) and are associated with potential adverse events (AEs). 
      However, few data are currently available on the risk of AEs in CS users in an 
      SLE population. OBJECTIVE: To examine AEs related to CS use and costs of treating 
      CS-related AEs in patients with SLE. METHODS: In a retrospective cohort study 
      using claims data (study period: January 1, 2000-June 30, 2010), patients aged 
      >/=18 years having >/=2 SLE-related (International Classification of Diseases, Ninth 
      Revision, Clinical Modification code 710.0x) outpatient or >/=1 inpatient/emergency 
      department claim were identified with an index diagnosis date deemed as the date 
      of first SLE diagnosis. Receipt of CS therapy was assessed within 6 months of the 
      index diagnosis date. Cox models were used to evaluate risk of AEs in CS users 
      and nonusers. Associated costs were computed for AEs where risk was significantly 
      different among the cohorts. RESULTS: Of 2717 patients with SLE, 989 received CSs 
      and 1728 did not. Users of CSs were ~1.5 times more likely to develop chronic AEs 
      (sleep disturbances, migraines, cataracts, hypertension, and type 2 diabetes 
      mellitus) and ~2 times more likely to develop acute AEs (pneumonia, herpes 
      zoster, fungal infections, and nausea/vomiting) compared with CS nonusers. The 
      mean annual cost for managing AEs was $4607 and was highest for diabetes mellitus 
      ($9764), hypertension ($8773), and sleep disturbances ($5599). Applying 
      differences in 1-year event rates (CS user: 58.1%; CS nonuser: 75.1%) to cost 
      estimates yielded an additional $784 per year per CS user to manage known 
      CS-related AEs compared with CS nonusers. CONCLUSIONS: Although CSs are 
      prescribed to control SLE symptoms, these results highlight potential risks and 
      costs associated with their use, which providers/payers should consider when 
      making treatment decisions.
CI  - Copyright (c) 2013. Published by EM Inc USA.
FAU - Shah, Manan
AU  - Shah M
AD  - Xcenda LLC, Palm Harbor, FL 34685, USA. manan.shah@bms.com
FAU - Chaudhari, Sham
AU  - Chaudhari S
FAU - McLaughlin, Trent P
AU  - McLaughlin TP
FAU - Kan, Hong J
AU  - Kan HJ
FAU - Bechtel, Benno
AU  - Bechtel B
FAU - Dennis, Gregory J
AU  - Dennis GJ
FAU - Molta, Charles T
AU  - Molta CT
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - Adrenal Cortex Hormones/*adverse effects/economics/therapeutic use
MH  - *Cost-Benefit Analysis
MH  - Dose-Response Relationship, Drug
MH  - Humans
MH  - Lupus Erythematosus, Systemic/*drug therapy
MH  - Retrospective Studies
EDAT- 2013/04/17 06:00
MHDA- 2013/10/18 06:00
CRDT- 2013/04/17 06:00
PHST- 2012/12/17 00:00 [received]
PHST- 2013/02/22 00:00 [revised]
PHST- 2013/03/05 00:00 [accepted]
PHST- 2013/04/17 06:00 [entrez]
PHST- 2013/04/17 06:00 [pubmed]
PHST- 2013/10/18 06:00 [medline]
AID - S0149-2918(13)00111-2 [pii]
AID - 10.1016/j.clinthera.2013.03.001 [doi]
PST - ppublish
SO  - Clin Ther. 2013 Apr;35(4):486-97. doi: 10.1016/j.clinthera.2013.03.001.