PMID- 28925768
OWN - NLM
STAT- MEDLINE
DCOM- 20190813
LR  - 20220410
IS  - 1532-4303 (Electronic)
IS  - 0277-0903 (Linking)
VI  - 55
IP  - 6
DP  - 2018 Jun
TI  - The impact of long-term systemic glucocorticoid use in severe asthma: A UK 
      retrospective cohort analysis.
PG  - 651-658
LID - 10.1080/02770903.2017.1353612 [doi]
AB  - OBJECTIVE: Systemic glucocorticoids (SGCs) are a treatment option for severe 
      asthma but are associated with the development of adverse events (AEs). Evidence 
      on the extent of SGC use and the relationship between SGC dose and AE risk in 
      severe asthma is limited. METHODS: Patients with severe asthma (Global Initiative 
      for Asthma step 4/5), with no SGC use during the <6-12 months before severe 
      asthma determination (index date) were identified in the UK-based Clinical 
      Practice Research Datalink database (2004-2012). Patients were assessed for SGC 
      exposure and an incident diagnosis of an SGC-related AE (cataracts, diabetes, 
      myocardial infarction [MI], osteoporosis, peptic ulcer or stroke) during the 
      8-year observation phase. The dose-related risk of an SGC-related AE was 
      determined using AE-specific Cox proportional hazards models. RESULTS: Overall, 
      75% of 60,418 patients identified with severe asthma received SGC during the 
      8-year follow-up, with the majority receiving an average of >0-</=2.5 mg/day. The 
      risk of diabetes (hazard ratio [HR]:1.20 [95% confidence interval (CI): 1.11, 
      1.30]), MI (HR: 1.25 [95% CI: 1.09, 1.43]) and osteoporosis (HR: 1.64 [95% CI: 
      1.51, 1.78]) was increased at low SGC doses (0-2.5 mg/day), with further risk 
      increases at doses >2.5 mg/day versus no SGC use. Compared with no SGC use, SGC 
      increased the risk of peptic ulcer in a non-dose-dependent manner, but the risk 
      of stroke was unchanged. CONCLUSIONS: 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.
FAU - Daugherty, Jonas
AU  - Daugherty J
AD  - a Department of Pharmaceutical Outcomes and Policy, UNC Eshelman School of 
      Pharmacy , University of North Carolina , Chapel Hill , NC , USA.
AD  - b Value Outcomes and Epidemiology , PAREXEL International , Research Triangle 
      Park , NC , USA.
FAU - Lin, Xiwu
AU  - Lin X
AD  - c Value Evidence and Outcomes , GSK , Collegeville , PA , USA.
FAU - Baxter, Richard
AU  - Baxter R
AD  - d GSK , Stevenage , UK.
FAU - Suruki, Robert
AU  - Suruki R
AD  - e Worldwide Epidemiology , GSK , Research Triangle Park , NC , USA.
AD  - f Epidemiology UCB Biosciences , Research Triangle Park , NC , USA.
FAU - Bradford, Eric
AU  - Bradford E
AD  - g Respiratory Therapeutic Area , GSK , Research Triangle Park , NC , USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170919
PL  - England
TA  - J Asthma
JT  - The Journal of asthma : official journal of the Association for the Care of 
      Asthma
JID - 8106454
RN  - 0 (Glucocorticoids)
MH  - Administration, Oral
MH  - Adult
MH  - Aged
MH  - Asthma/diagnosis/*drug therapy
MH  - Cataract/chemically induced/epidemiology
MH  - Databases, Factual/statistics & numerical data
MH  - Diabetes Mellitus, Type 2/chemically induced/epidemiology
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Glucocorticoids/administration & dosage/*adverse effects
MH  - Humans
MH  - Incidence
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/chemically induced/epidemiology
MH  - Osteoporosis/chemically induced/epidemiology
MH  - Peptic Ulcer/chemically induced/epidemiology
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke/chemically induced/epidemiology
MH  - Time Factors
MH  - United Kingdom/epidemiology
MH  - Young Adult
OTO - NOTNLM
OT  - Adverse event
OT  - claims database
OT  - diabetes
OT  - myocardial infarction
OT  - oral glucocorticoids
OT  - osteoporosis cataracts
OT  - peptic ulcer
OT  - pharmacology
OT  - stroke
EDAT- 2017/09/20 06:00
MHDA- 2019/08/14 06:00
CRDT- 2017/09/20 06:00
PHST- 2017/09/20 06:00 [pubmed]
PHST- 2019/08/14 06:00 [medline]
PHST- 2017/09/20 06:00 [entrez]
AID - 10.1080/02770903.2017.1353612 [doi]
PST - ppublish
SO  - J Asthma. 2018 Jun;55(6):651-658. doi: 10.1080/02770903.2017.1353612. Epub 2017 
      Sep 19.