PMID- 29741130 OWN - NLM STAT- MEDLINE DCOM- 20191021 LR - 20191022 IS - 1473-4877 (Electronic) IS - 0300-7995 (Linking) VI - 34 IP - 8 DP - 2018 Aug TI - Quantitative characterization of the relationship between levels of extended corticosteroid use and related adverse events in a US population. PG - 1519-1527 LID - 10.1080/03007995.2018.1474090 [doi] AB - OBJECTIVE: This retrospective study assessed the incidence and timing of adverse events (AEs) among patients prescribed varying dose levels of corticosteroids in the US. METHODS: Patients with selected autoimmune or inflammatory disease diagnoses between 2006 and 2015 were identified from a privately insured administrative database. Patients were stratified into treatment cohorts based on dosage and length of corticosteroid use: intermittent use with duration <60 days, and three extended use cohorts with duration >/=60 days at low (7.5-15 mg/day) prednisone-equivalent dosage. The incidence of and time to corticosteroid-related AEs were assessed by cohort. RESULTS: A total of 78,704 patients met the selection criteria, of whom 9.5%, 11.0% and 8.6% were classified into the high-, medium-, and low-dose extended corticosteroid use cohorts, respectively. Corticosteroid exposure varied across study conditions, from 34% of dermatomyositis/polymyositis to 6% of psoriatic arthritis patients prescribed extended high dose. Hypertension, pneumonia and osteoporosis were the AEs with the highest incidence rates (41.9, 27.4 and 19.8 cases respectively per 1000 patient-months for the high-dose cohort). For most AEs, all levels of extended corticosteroid use exhibited significant risks of increased incidence compared to intermittent use. Some AEs had dose relationships, with higher dose correlated with higher incidence; other AEs had duration relationships with longer duration correlated with higher incidence regardless of dose. Average time to AE onset was relatively short, occurring at 2.3-6.7 months after corticosteroid initiation. CONCLUSIONS: Through a rigorous quantitative characterization, extended steroid exposure was associated with increased incidence and earlier onset of AEs among privately insured adults in the US. FAU - Rice, J Bradford AU - Rice JB AD - a Analysis Group Inc. , Boston , MA , USA. FAU - White, Alan G AU - White AG AD - a Analysis Group Inc. , Boston , MA , USA. FAU - Johnson, Michaela AU - Johnson M AD - a Analysis Group Inc. , Boston , MA , USA. FAU - Wagh, Aneesha AU - Wagh A AD - a Analysis Group Inc. , Boston , MA , USA. FAU - Qin, Yimin AU - Qin Y AD - b Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research , Bedminster , NJ , USA. FAU - Bartels-Peculis, Laura AU - Bartels-Peculis L AD - b Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research , Bedminster , NJ , USA. FAU - Ciepielewska, Gosia AU - Ciepielewska G AD - b Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research , Bedminster , NJ , USA. FAU - Nelson, Winnie W AU - Nelson WW AD - b Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research , Bedminster , NJ , USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180523 PL - England TA - Curr Med Res Opin JT - Current medical research and opinion JID - 0351014 RN - 0 (Adrenal Cortex Hormones) SB - IM MH - Adrenal Cortex Hormones/*adverse effects/therapeutic use MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Time Factors OTO - NOTNLM OT - Autoimmune diseases OT - adverse events OT - corticosteroids OT - dose-dependent response EDAT- 2018/05/10 06:00 MHDA- 2019/10/23 06:00 CRDT- 2018/05/10 06:00 PHST- 2018/05/10 06:00 [pubmed] PHST- 2019/10/23 06:00 [medline] PHST- 2018/05/10 06:00 [entrez] AID - 10.1080/03007995.2018.1474090 [doi] PST - ppublish SO - Curr Med Res Opin. 2018 Aug;34(8):1519-1527. doi: 10.1080/03007995.2018.1474090. Epub 2018 May 23.