Acute and chronic systemic corticosteroid–related complications in patients with severe asthma - 04/12/15
, Mei Sheng Duh, MPH, ScD b, Marie-Hélène Lafeuille, MA a, Laurence Gozalo, PhD a, Urvi Desai, PhD b, Marie-Noëlle Robitaille, MA a, Frank Albers, MD, PhD c, Steve Yancey, MSc c, Hector Ortega, MD, ScD c, Mark Forshag, MD c, Xiwu Lin, PhD c, Anand A. Dalal, PhD, MBA, BPharm cAbstract |
Background |
Many patients with severe asthma require maintenance treatment with systemic corticosteroids (SCSs) to control daily symptoms and prevent serious acute exacerbations, but chronic SCS use is associated with complications.
Objective |
We sought to evaluate the risk of SCS-related complications by SCS exposure and quantify the associated health care costs and resource use in patients with severe asthma.
Methods |
We performed a longitudinal, open-cohort, observational study using health insurance claims data (1997-2013: Medicaid) from Florida, Iowa, Kansas, Missouri, Mississippi, and New Jersey. Eligible patients were 12 years old or older with 2 or more asthma diagnoses and had more than 6 months of continuous SCS use. An open-cohort approach was used to classify patients' follow-up into low, medium, and high SCS exposure (≤6, >6-12, and >12 mg/d, respectively). Multivariate generalized estimating equation models were used to estimate the adjusted risk of SCS-related complications for patients with medium and high exposure compared with patients with low exposure and quantify the resulting health care resource use and costs.
Results |
The study included 3628 patients (mean age, 57.6 years; 68% female). Patients with medium and high SCS exposure had significantly higher risks of SCS-related complications, including infections and cardiovascular, metabolic, psychiatric, ocular, gastrointestinal, and bone-related complications (odds ratio, 1.23-2.12 by complication; P < .05 for all but one) versus those with low (reference group) SCS exposure. Medium and high SCS exposure were also associated with significantly more emergency department visits (incidence rate ratios, 1.31 [P = .0004] and 1.78 [P < .0001]) and inpatient visits (incidence rate ratios, 1.25 [P < .0001] and 1.59 [P < .0001]) versus low SCS exposure.
Conclusions |
A significant dose-response relationship was demonstrated between chronic SCS use and risk of SCS-related complications in patients with severe asthma. Effective SCS-sparing strategies might reduce the burden associated with SCS-related complications in patients with severe asthma.
Le texte complet de cet article est disponible en PDF.Key words : Systemic corticosteroids, severe asthma, health care use, dose response, corticosteroid-related complications, cost
Abbreviations used : CCI, GEE, ICD-9-CM, ICS, OR, QIC, SCS
Plan
| Supported by GlaxoSmithKline (study no. HO-13-12748). Editorial support was also funded by GlaxoSmithKline. |
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| Disclosure of potential conflict of interest: P. Lefebvre and M.-N. Robitaille have received research support from GlaxoSmithKline. M. S. Duh has received research support from GlaxoSmithKline, Janssen, Novo Nordisk, Novartis, Ariad, Pfizer, Sanofi, and Bayer. M.-H. Lafeuille, L. Gozalo, and U. Desai are employed by Groupe d'analyse, a research company that has received research grants from GlaxoSmithKline. F. Albers, S. Yancey, H. Ortega, M. Forshag, X. Lin, and A. A. Dalal are employed by and have stock/stock options in GlaxoSmithKline. |
Vol 136 - N° 6
P. 1488-1495 - décembre 2015 Retour au numéro
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