The burden of intermittent oral corticosteroid use in asthma

Clinical Research Results Abstract Introduction: Oral corticosteroids (OCS) are widely prescribed for asthma exacerbations;1,2 however, little is known of how intermittent OCS use relates to OCS-related adverse event (AE) risk. We assessed the association between different patterns of intermittent OCS use and AEs in patients with asthma.Methods: Historical cohort study of UK patients ≥4 years old using the Optimum Patient Care Research Database and Clinical Practice Research Datalink (2008–2019). Patients receiving intermittent OCS were categorised by OCS prescribing pattern based on gap between prescriptions (only 1 [once-only], >1 with any gaps >90-days but no gap <90-day [less frequent], and >1 with <90-day gap(s) [frequent]) and indexed on the first intermittent OCS prescription within 3 months of an asthma-related event; OCS-naïve patients matched on gender, age, and index date served as controls. We excluded patients with long-term OCS treatment, chronic conditions treated with OCS, or AEs pre-index. Incidence of first AE post-index was measured. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using multivariable Cox regression.Results: Of 2,130,881 patients receiving an OCS prescription, 476,167 met eligibility criteria; 476,167 OCS-naïve patients were included. Proportion of females, mean age, and median baseline follow-up were similar between OCS and OCS-naïve patients. Of 476,167 patients, 41.7%, 26.8%, and 31.6% had once-only, less frequent, and frequent OCS use during the follow-up, respectively (Table). The HR (95% CI) of experiencing any AE versus non-OCS use was 1.19 (1.18, 1.20) for once-only, 1.35 (1.34, 1.36) for less frequent, and 1.42 (1.42, 1.43) for frequent OCS. The risk of individual OCS-related AEs largely increased with more frequent patterns of intermittent OCS use (Figure).Discussion: Among patients with asthma with intermittent OCS use, more new OCS-related AEs were observed within categories of more frequent use patterns, suggesting that intermittent OCS for managing asthma should be limited where possible. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest AstraZeneca funded the study. AstraZeneca and OPRI had a role in study design, data collection, data analysis, data interpretation, and writing of the report. This study was approved by the Anonymised Data Ethics & Protocol Transparency (ADEPT) Committee (OPCRD; ADEPT1120), the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP; registration number: EUPAS37065) and the Independent Scientific Advisory Committee (CPRD; ISAC 20_000071). References and Clinical Trial Registry Information Tran TN, et al. Eur Respir J. 2020;55(6):1902363. doi: 10.1183/13993003.02363-2019. GINA. Global strategy for asthma management and prevention 2021 (https://ginasthma.org/gina-reports/).