PMID- 28456623
OWN - NLM
STAT- MEDLINE
DCOM- 20190715
LR  - 20220410
IS  - 1097-6825 (Electronic)
IS  - 0091-6749 (Linking)
VI  - 141
IP  - 1
DP  - 2018 Jan
TI  - Oral corticosteroid exposure and adverse effects in asthmatic patients.
PG  - 110-116.e7
LID - S0091-6749(17)30680-2 [pii]
LID - 10.1016/j.jaci.2017.04.009 [doi]
AB  - BACKGROUND: Significant adverse effects (AEs) have been associated with 
      continuous exposure to oral corticosteroids (OCSs). The potential association 
      with intermittent exposure is unknown. OBJECTIVE: We sought to assess the 
      association between OCSs and AEs based on the number of OCS prescriptions. 
      METHODS: This was a retrospective cohort study of asthmatic patients 18 years and 
      older in the 2000-2014 MarketScan data set. Propensity score matching was used at 
      baseline (12 months before the index date: first OCS use). Logistic regression 
      was used to examine the association between OCSs and new incident AEs (either 
      combined or individual) controlling for covariates. Follow-up continued for 
      24 months minimum and 10 years maximum after the index date. RESULTS: There were 
      72,063 and 156,373 subjects in the OCS and no OCS cohorts, respectively. Subjects 
      taking 4 or more OCS (1-3) prescriptions within the year had 1.29 (1.04) times 
      the odds of experiencing a new AE within the year. Each year of exposure to 4 or 
      more OCS prescriptions (current and past) resulted in 1.20 times the odds of 
      having an AE in the current year. Exposure to 4 or more prescriptions was 
      associated with significantly greater odds of AEs for osteoporosis, hypertension, 
      obesity, type 2 diabetes, gastrointestinal ulcers/bleeds, fractures, and 
      cataracts (odds, 1.21-1.44 depending on the AE). CONCLUSION: Although previous 
      research has documented the deleterious effect of continuous OCS exposure in 
      patients with severe asthma, our results suggest that each OCS prescription might 
      result in a cumulative burden on current and future health regardless of dose and 
      duration. OCS-sparing strategies are extremely important to improve patient 
      outcomes.
CI  - Copyright (c) 2017 American Academy of Allergy, Asthma & Immunology. Published by 
      Elsevier Inc. All rights reserved.
FAU - Sullivan, Patrick W
AU  - Sullivan PW
AD  - Regis University School of Pharmacy, Denver, Colo. Electronic address: 
      psulliva@regis.edu.
FAU - Ghushchyan, Vahram H
AU  - Ghushchyan VH
AD  - Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, 
      University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, 
      Armenia.
FAU - Globe, Gary
AU  - Globe G
AD  - Amgen, Thousand Oaks, Calif.
FAU - Schatz, Michael
AU  - Schatz M
AD  - Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170427
PL  - United States
TA  - J Allergy Clin Immunol
JT  - The Journal of allergy and clinical immunology
JID - 1275002
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - Administration, Oral
MH  - Adrenal Cortex Hormones/administration & dosage/*adverse effects
MH  - Adult
MH  - *Asthma/drug therapy/epidemiology
MH  - Cataract/chemically induced/epidemiology
MH  - Diabetes Mellitus, Type 2/chemically induced/epidemiology
MH  - Female
MH  - Fractures, Bone/chemically induced/epidemiology
MH  - Gastrointestinal Hemorrhage/chemically induced/epidemiology
MH  - Humans
MH  - Hypertension/chemically induced/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Obesity/chemically induced/epidemiology
MH  - Osteoporosis/chemically induced/epidemiology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Oral corticosteroids
OT  - adverse effects
OT  - burst therapy
OT  - severe asthma
EDAT- 2017/05/01 06:00
MHDA- 2019/07/16 06:00
CRDT- 2017/05/01 06:00
PHST- 2016/11/07 00:00 [received]
PHST- 2017/03/23 00:00 [revised]
PHST- 2017/04/03 00:00 [accepted]
PHST- 2017/05/01 06:00 [pubmed]
PHST- 2019/07/16 06:00 [medline]
PHST- 2017/05/01 06:00 [entrez]
AID - S0091-6749(17)30680-2 [pii]
AID - 10.1016/j.jaci.2017.04.009 [doi]
PST - ppublish
SO  - J Allergy Clin Immunol. 2018 Jan;141(1):110-116.e7. doi: 
      10.1016/j.jaci.2017.04.009. Epub 2017 Apr 27.