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.