Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study

Patients with respiratory conditions are commonly prescribed systemic corticosteroids (SCS), which are also used to treat or reduce the risk of flareups of inflammatory conditions, such as rheumatological and autoimmune diseases, allergic reactions and inflammatory bowel disease. Their maintenance use raises concerns regarding increased risk of infections and cardiovascular events, type 2 diabetes mellitus, osteoporosis, cataracts, weight gain, insomnia, depression and behavioural disturbances. Even short-term use of oral corticosteroids (OCS) is associated with increased rates of sepsis, thromboembolism and fracture within 30 days of OCS initiation.

SCS are a mainstay of treatment for asthma exacerbations, and are often prescribed as part of a daily maintenance therapy for patients with severe asthma.

In this long-term, observational study of a broad population of patients with active asthma of all levels of severity, Price and colleagues set out to investigate the impact of initiating SCS (and of SCS exposure) on known SCS-associated adverse outcomes.

Using anonymised, longitudinal medical record data, the historical matched cohort study of patients (n = 307,213) with active asthma compared those initiating SCS with those not exposed to SCS, and comprised a minimum one-year baseline period and a minimum two-year follow-up period. Patients were at least 18 years of age with no less than three years-worth of continuous practice records.

The study findings, in a broad asthma population initiating SCS, including both acute and maintenance SCS, and followed over a median exposure period of more than seven years, indicate that increasing cumulative exposure and increasing mean daily exposure to SCS places patients at a high risk of potentially life-changing SCS-related adverse outcomes, which have a substantial financial impact on the health system. This finding is both statistically and clinically important, as increased risks of adverse outcomes were seen at relatively low cumulative and mean daily SCS exposures.

An important practical implication of this finding is that patients should be evaluated and considered for alternative treatment strategies in the course of their asthma to avoid the need of OCS.

This study was funded by AstraZeneca.