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Increased systemic corticosteroid exposure raises risk for complications among those with severe asthma

Greater exposure to chronic systemic corticosteroids appeared to elevate risk for complications among patients with severe asthma, according to results of a longitudinal, open-cohort, observational study.

Patrick Lefebvre, MA, of Groupe d'analyse in Montreal, and colleagues used Medicaid data from six states to evaluate the association between systemic corticosteroid (SCS) exposure and risk for related complications among 3,628 patients aged 12 and older with severe asthma.

Sixty-eight percent of study participants were female, and the mean age was 57.6 years.

All study participants had more than two diagnoses of asthma with 6 months of continuous SCS use. Investigators divided participants into three groups based on SCS exposure: low (≤ 6 mg/day), medium (> 6 mg/day to 12 mg/day), and high (> 12 mg/day).

Participants in the medium- and high-exposure groups were significantly more likely to experience infections, as well as cardiovascular, psychiatric, ocular, gastrointestinal, metabolic and bone-related complications (OR range = 1.23 to 2.12; P < .05 for all but one) compared with those in the low-exposure group.

Participants in the medium- and high-exposure groups also demonstrated significantly greater risk for ED visits (incidence rate ratio [IRR] for medium exposure = 1.31; P = .0004; IRR for high exposure = 1.78; P < .0001) and inpatient visits (IRR for medium exposure = 1.25; P < .0001; IRR for high exposure = 1.59; P < .0001) than those with low SCS exposure.

“A significant dose-response relationship was demonstrated between chronic SCS use and risk of SCS-related complications in patients with severe asthma,” Lefebvre and colleagues wrote. “Effective SCS-sparing strategies might reduce the burden associated with SCS-related complications in patients with severe asthma.” – by Jeff Craven

Disclosure: The researchers report research support from Ariad, Bayer, GlaxoSmithKline, Janssen, Novo Nordisk, Novartis, Pfizer and Sanofi, as well as employment with and stock options from GlaxoSmithKline.