Adverse consequences of systemic corticosteroids use among a broad population of US adults with asthma: a real-world analysis.

Aims: Systemic corticosteroids (SCS) are used to manage asthma exacerbations. Among the broad population of patients with asthma, SCS-related risk of adverse events (AEs), health care resource utilization (HCRU), and costs remain unclear.

Materials and methods: This retrospective cohort study used the Optum Research Database claims to identify adults with asthma from 1/1/2017-6/30/2022. The index date was the earliest SCS claim for SCS users; non-SCS users were randomly selected and adjusted proportionally to SCS users by index year. SCS use was measured during the first 12 months of follow-up. Inverse probability of treatment weighting balanced the two cohorts for selected baseline demographic and clinical characteristics. SCS users were further stratified into low, medium, and high dose sub-cohorts. SCS-related AEs were assessed up to 48 months, while HCRU and costs were assessed during the first 12 months of follow-up. A generalized linear model (GLM) analyzed follow-up costs by SCS exposure.

Results: The 130,739 patients included 55,363 non-SCS users (42.3%), while 75,376 were SCS users stratified into 60,319 low-, 12,235 medium-, and 2,822 high-dose users. Mean age was 49.6 years; 61.8% were female and 68.9% were non-Hispanic White. SCS users had significantly greater risk of new-onset acute and chronic SCS-related AEs, increasing incrementally with dose exposure (all p < 0.001) across numerous physiological systems. Follow-up HCRU and costs also rose incrementally with dose exposure (all p < 0.001). Compared with non-users, SCS-related costs were 1.43, 1.97, and 3.21 times higher among low-, medium-, and high-dose users, respectively. The adjusted GLM predicted a 9.9% cost increase per 100 mg of prednisone equivalents.

Limitations: Retrospective administrative claims studies cannot randomize patients and may not capture all patient events.

Conclusions: Among a broad population of adults with asthma, even low doses of SCS were associated with significantly increased risk of new-onset AEs, HCRU, and costs.