An observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma

Heath  Heatley; Arnoud Bourdin; Andrew Menzies-Gow; David J Jackson; Ekatarina  Maslova; Jatin  Chapaneri; Derek Skinner; Victoria Carter; Jeffrey  Shi Kai Chan; Cono  Ariti; John Haughney; David Price

doi:10.1136/thorax-2022-219642

An observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma

Heath Heatley, Arnoud Bourdin, Andrew Menzies-Gow, David J Jackson, Ekatarina Maslova, Jatin Chapaneri, Derek Skinner, Victoria Carter, Jeffrey Shi Kai Chan, Cono Ariti, John Haughney, David Price^* (Corresponding Author)

^*Corresponding author for this work

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Abstract

Introduction
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.
Methods
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.
Findings
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.
Conclusion
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.

Original language	English
Number of pages	8
Journal	Thorax
Early online date	27 Dec 2022
DOIs	https://doi.org/10.1136/thorax-2022-219642
Publication status	E-pub ahead of print - 27 Dec 2022

Bibliographical note

Funding
AstraZeneca funded the study (grant/award number: not applicable). AstraZeneca and OPRI had a role in study design, data collection, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and had final responsibility to submit for publication.

Acknowledgements
We would like to thank Sam Hijazi and Stefan Courtney of in Science Communications, Springer Healthcare Ltd, UK for providing medical writing support, which was funded by AstraZeneca in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3)

Data Availability Statement

Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data sharing policy described at
https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.

Keywords

Asthma

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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Cite this

Heatley, H., Bourdin, A., Menzies-Gow, A., Jackson, D. J., Maslova, E., Chapaneri, J., Skinner, D., Carter, V., Shi Kai Chan, J., Ariti, C., Haughney, J., & Price, D. (2022). An observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma. Thorax. Advance online publication. https://doi.org/10.1136/thorax-2022-219642

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title = "An observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma",

abstract = "IntroductionOral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (AOs); no previous study has focused exclusively on intermittent OCS use.Methods 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. Findings 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. Conclusion 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.",

keywords = "Asthma",

author = "Heath Heatley and Arnoud Bourdin and Andrew Menzies-Gow and Jackson, {David J} and Ekatarina Maslova and Jatin Chapaneri and Derek Skinner and Victoria Carter and {Shi Kai Chan}, Jeffrey and Cono Ariti and John Haughney and David Price",

note = "Funding AstraZeneca funded the study (grant/award number: not applicable). AstraZeneca and OPRI had a role in study design, data collection, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and had final responsibility to submit for publication. Acknowledgements We would like to thank Sam Hijazi and Stefan Courtney of in Science Communications, Springer Healthcare Ltd, UK for providing medical writing support, which was funded by AstraZeneca in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3)",

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doi = "10.1136/thorax-2022-219642",

language = "English",

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issn = "0040-6376",

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TY - JOUR

T1 - An observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma

AU - Heatley, Heath

AU - Bourdin, Arnoud

AU - Menzies-Gow, Andrew

AU - Jackson, David J

AU - Maslova, Ekatarina

AU - Chapaneri, Jatin

AU - Skinner, Derek

AU - Carter, Victoria

AU - Shi Kai Chan, Jeffrey

AU - Ariti, Cono

AU - Haughney, John

AU - Price, David

N1 - Funding AstraZeneca funded the study (grant/award number: not applicable). AstraZeneca and OPRI had a role in study design, data collection, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and had final responsibility to submit for publication. Acknowledgements We would like to thank Sam Hijazi and Stefan Courtney of in Science Communications, Springer Healthcare Ltd, UK for providing medical writing support, which was funded by AstraZeneca in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3)

PY - 2022/12/27

Y1 - 2022/12/27

N2 - IntroductionOral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (AOs); no previous study has focused exclusively on intermittent OCS use.Methods 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. Findings 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. Conclusion 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.

AB - IntroductionOral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (AOs); no previous study has focused exclusively on intermittent OCS use.Methods 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. Findings 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. Conclusion 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.

KW - Asthma

U2 - 10.1136/thorax-2022-219642

DO - 10.1136/thorax-2022-219642

M3 - Article

C2 - 36575040

SN - 0040-6376

JO - Thorax

JF - Thorax

ER -

An observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma

Abstract

Bibliographical note

Data Availability Statement

Keywords

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