Abstract
Purpose: Associations between systemic glucocorticoid (SGC) exposure and risk for adverse outcomes have spurred a move toward steroid-sparing treatment strategies. Real-world changes in SGC exposure over time, after the introduction of steroid-sparing treatment strategies, reveal areas of successful risk mitigation as well as unmet needs.
Patients and methods: A population-based ecological study was performed from the Optimum Patient Care Research Database to describe SGC prescribing trends of steroid-sparing treatment strategies in primary care practices before and after licensure of biologics in the United Kingdom from 1990 to 2019. Each analysis year included patients aged ≥5 years who were registered for ≥1 year with a participating primary care practice. The primary analysis was SGC exposure, defined as total cumulative SGC dose per patient per year, for asthma, severe asthma, chronic obstructive pulmonary disease (COPD), nasal polyps, Crohn’s disease, rheumatoid arthritis, ulcerative colitis, and systemic lupus erythematosus.
Secondary outcomes were percentages of patients prescribed SGCs and number of SGC prescriptions per patient per year.
Results: The number of patients who met study inclusion criteria ranged from 219,862 (1990) to 1,261,550 (2019). At the population level, patients with asthma or COPD accounted for 67.7% to 73.2% of patients per year with an SGC prescription. Over three decades, decreases in SGC total yearly dose ≥1000 mg have been achieved in multiple conditions. Patients with COPD prescribed SGCs increased from 5.8% (1990) to 34.8% (2017). SGC prescribing trends for severe asthma, Crohn’s disease, and ulcerative colitis show decreased prescribing trends after the introduction of biologics.
Conclusions: Decreases in total yearly SGC doses have been shown in multiple conditions; however, for conditions such as severe asthma and COPD, an unmet need remains for increased awareness of SGC burden and the adoption or development of SGC-sparing alternatives to reduce overuse
Patients and methods: A population-based ecological study was performed from the Optimum Patient Care Research Database to describe SGC prescribing trends of steroid-sparing treatment strategies in primary care practices before and after licensure of biologics in the United Kingdom from 1990 to 2019. Each analysis year included patients aged ≥5 years who were registered for ≥1 year with a participating primary care practice. The primary analysis was SGC exposure, defined as total cumulative SGC dose per patient per year, for asthma, severe asthma, chronic obstructive pulmonary disease (COPD), nasal polyps, Crohn’s disease, rheumatoid arthritis, ulcerative colitis, and systemic lupus erythematosus.
Secondary outcomes were percentages of patients prescribed SGCs and number of SGC prescriptions per patient per year.
Results: The number of patients who met study inclusion criteria ranged from 219,862 (1990) to 1,261,550 (2019). At the population level, patients with asthma or COPD accounted for 67.7% to 73.2% of patients per year with an SGC prescription. Over three decades, decreases in SGC total yearly dose ≥1000 mg have been achieved in multiple conditions. Patients with COPD prescribed SGCs increased from 5.8% (1990) to 34.8% (2017). SGC prescribing trends for severe asthma, Crohn’s disease, and ulcerative colitis show decreased prescribing trends after the introduction of biologics.
Conclusions: Decreases in total yearly SGC doses have been shown in multiple conditions; however, for conditions such as severe asthma and COPD, an unmet need remains for increased awareness of SGC burden and the adoption or development of SGC-sparing alternatives to reduce overuse
| Original language | English |
|---|---|
| Pages (from-to) | 53-64 |
| Number of pages | 12 |
| Journal | Pragmatic and Observational Research |
| Volume | 2024 |
| Issue number | 15 |
| Early online date | 15 Mar 2024 |
| DOIs | |
| Publication status | Published - 15 Mar 2024 |
Bibliographical note
AcknowledgmentsThe authors thank the members of the Forum for reducing Oral Corticosteroid Use in Severe asthma (FOCUS) for their involvement in the conception of the study (Table S5). Medical writing support, including preparation of the draft manuscript under the direction and guidance of the authors, incorporating author feedback, and manuscript submission, was provided by Lea Anne Gardner, PhD, RN (CiTRUS Health Group), in accordance with Good Publication Practice 2022 (GPP 2022) guidelines. This support was funded by AstraZeneca (Cambridge, UK). Data from OPCRD were obtained under license from Optimum Patient Care Limited. The interpretation and conclusions contained in this report are those of the authors alone.
Funding
This work was funded by AstraZeneca. In collaboration with the steering committee, AstraZeneca was involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the article for publication. All authors had full access to the data,
agreed to be accountable for the accuracy and integrity of the work, and shared responsibility for the decision to submit the article for publication. Steering committee members were not compensated for their participation.
Keywords
- Glucocorticoids
- Practice Patterns
- Drug prescriptions
- Biological products
- Drug utilization