PT  - JOURNAL ARTICLE
AU  - Heatley, Heath
AU  - Tran, Trung N
AU  - Bourdin, Arnaud
AU  - Menzies-Gow, Andrew
AU  - Jackson, David J
AU  - Maslova, Ekaterina
AU  - Chapaneri, Jatin
AU  - Skinner, Derek
AU  - Carter, Victoria
AU  - Chan, Jeffrey Shi Kai
AU  - Ariti, Con
AU  - Haughney, John
AU  - Price, David B
TI  - Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma
AID  - 10.1136/thorax-2022-219642
DP  - 2023 Sep 01
TA  - Thorax
PG  - 860--867
VI  - 78
IP  - 9
4099  - http://thorax.bmj.com/content/78/9/860.short
4100  - http://thorax.bmj.com/content/78/9/860.full
SO  - Thorax2023 Sep 01; 78
AB  - Introduction Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (adverse outcomes); 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 (<90 day gap). Non-OCS patients matched 1:1 on gender, age and index date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, Global Initiative for Asthma (GINA) 2020 treatment step, and pre index inhaled corticosteroid (ICS) and short-acting β2-agonist (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 (HR; 95% CI: one-off 1.19 (1.18 to 1.20), less frequent 1.35 (1.34 to 1.36), frequent 1.42 (1.42 to 1.43)), and was consistent across age, GINA treatment step and ICS and SABA subgroups. The highest risks of individual OCS-related adverse outcomes 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 adverse outcomes. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.Data are available upon reasonable request.