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. 2017 Jan;33(1):57-65.
doi: 10.1080/03007995.2016.1233101. Epub 2016 Oct 14.

Burden of systemic glucocorticoid-related complications in severe asthma

Patrick Lefebvre  1 , Mei Sheng Duh  2 , Marie-Hélène Lafeuille  1 , Laurence Gozalo  1 , Urvi Desai  2 , Marie-Noëlle Robitaille  1 , Frank Albers  3 , Steve Yancey  3 , Hector Ortega  3 , Mark Forshag  3 , Xiwu Lin  3 , Anand A Dalal  3
Affiliations

Burden of systemic glucocorticoid-related complications in severe asthma

Patrick Lefebvre et al. Curr Med Res Opin. 2017 Jan.

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.

Keywords: Economic burden; healthcare cost; severe asthma; systemic glucocorticoids.

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