Burden of systemic glucocorticoid-related complications in severe asthma. (2nd January 2017)

• Record Type: Journal Article
• Authors: Lefebvre, Patrick; Duh, Mei Sheng; Lafeuille, Marie-Hélène; Gozalo, Laurence; Desai, Urvi; Robitaille, Marie-Noëlle; Albers, Frank; Yancey, Steve; Ortega, Hector; Forshag, Mark; Lin, Xiwu; Dalal, Anand A.
• Is Part Of: Current medical research and opinion. Volume 33:Number 1(2017)
• Page Start: 57
• Page End: 65
• Publication Date: 2017-01-02
• Subjects: Economic burden -- healthcare cost -- severe asthma -- systemic glucocorticoids; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2016.1233101
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Objectives: Although systemic glucocorticoids (SGCs) are efficacious, their chronic use is associated with a range of complications. Yet limited data are available about the risks following chronic use in patients with severe asthma, who are at risk of long-term SGC-related complications. This study was carried out to investigate the risks of developing SGC-related complications, and to quantify the associated healthcare resource utilization and costs for patients with severe asthma in the United States. Methods: This was a longitudinal, open-cohort, observational study. Medicaid claims data (1997–2013) for patients ≥12 years old with ≥2 asthma diagnoses were used. A total of 26, 987 SGC non-users were identified for inclusion in the study, alongside 3628 SGC users with ≥6 months' continuous SGC use. Results: Multivariate generalized estimating equation models were used to estimate the adjusted risk of developing SGC-related complications, and to quantify the associated healthcare resource utilization and costs. This analysis compared SGC users with SGC non-users, and found that SGC users had an increased likelihood of developing complications. A significant dose–response relationship was demonstrated between chronic SGC use and risk of developing any complications (odds ratios for low, medium, and high SGC exposure were 2.03 [ p = .0511], 2.85 [ p < .0001], and 3.64 [ p < .0001], respectively, vs. SGC non-users). The increased likelihood of SGC-related complications translated into estimated annual healthcare costs for SGC users of $2712 to $8560 above those of SGC non-users. A key limitation of this study is the disparity in age between the SGC users and the SGC non-users; however, age was included as a confounding factor in the analysis. Conclusions: These findings confirm the risk associated with chronic use of SGCs, irrespective of dose level, and highlight the need for new SGC-sparing treatment strategies for patients with severe asthma.