Abstract
BackgroundOral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort.MethodsWe used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥ 2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression.Results21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p < 0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p < 0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis.ConclusionsThis population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.
Highlights
Oral corticosteroids are important components of pharmacotherapy in severe asthma
The far-reaching implications of lower exposure to systemic corticosteroids necessitate a more precise estimation of the current and future patterns of systemic corticosteroids use in severe asthma
Due to the one-year requirement for the case definition, not all asthma cases were captured during the last year of observation (2014), the analysis of trends was restricted to the 2000–2013 period
Summary
Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objec‐ tive was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort. Compared to the general asthma population, these patients suffer from a higher rate of Studying the patterns and trends in the use of systemic corticosteroids is timely. Sadatsafavi et al Respir Res (2021) 22:103 biologics with marked effects in patients with severe asthma have been or are being developed The hallmark of these studies has been a reduction in exacerbation frequency and the associated episodic oral corticosteroid (OCS) use [10, 11]. Such therapies have resulted in lower dependence on maintenance OCS therapy in many patients [12, 13]. The far-reaching implications of lower exposure to systemic corticosteroids necessitate a more precise estimation of the current and future patterns of systemic corticosteroids use in severe asthma
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