Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (AOs); no previous study has focused exclusively on intermittent OCS use.
This historical (2008-2019) UK cohort study using primary care medical records from two anonymised, real-life databases (OPCRD and CPRD) included patients aged ≥4 years with asthma receiving only intermittent OCS. Patients were indexed on their first recorded intermittent OCS prescription for asthma and categorised by OCS prescribing patterns: one-off (single), less frequent (≥90-day gap) and frequent (date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, GINA 2020 treatment step, and pre-index ICS and SABA prescriptions using a multivariable Cox-proportional hazard model.
Of 476,167 eligible patients, 41.7%, 26.8% and 31.6% had one-off, less frequent and frequent intermittent OCS prescribing patterns, respectively. Risk of any AO increased with increasingly frequent patterns of intermittent OCS versus non-OCS (hazard ratios [HR; 95% confidence interval]: one-off 1.19 [1.18-1.20], less frequent 1.35 [1.34-1.36], frequent 1.42 [1.42-
1.43]), and was consistent across age, GINA treatment step, and ICS and SABA subgroups. The highest risks of individual OCS-related AOs with increasingly frequent OCS were for pneumonia and sleep apnoea.
A considerable proportion of patients with asthma receiving intermittent OCS experienced a frequent prescribing pattern. Increasingly frequent OCS prescribing patterns were associated with higher risk of OCS-related AOs. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.
AstraZeneca funded the study (grant/award number: not applicable). AstraZeneca and OPRI had a role in study design, data collection, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and had final responsibility to submit for publication.
We would like to thank Sam Hijazi and Stefan Courtney of in Science Communications, Springer Healthcare Ltd, UK for providing medical writing support, which was funded by AstraZeneca in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3)
Data Availability StatementData underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data sharing policy described at