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.
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.
Entities:
Keywords:
Economic burden; healthcare cost; severe asthma; systemic glucocorticoids
Authors: David B Price; Frank Trudo; Jaco Voorham; Xiao Xu; Marjan Kerkhof; Joanna Ling Zhi Jie; Trung N Tran Journal: J Asthma Allergy Date: 2018-08-29
Authors: Christer Janson; Karin Lisspers; Björn Ställberg; Gunnar Johansson; Gunilla Telg; Marcus Thuresson; Helene Nordahl Christensen; Kjell Larsson Journal: Respir Res Date: 2018-09-03
Authors: Giorgio Walter Canonica; Giorgio Lorenzo Colombo; Giacomo Matteo Bruno; Sergio Di Matteo; Chiara Martinotti; Francesco Blasi; Caterina Bucca; Nunzio Crimi; Pierluigi Paggiaro; Girolamo Pelaia; Giovanni Passalaqua; Gianenrico Senna; Enrico Heffler Journal: World Allergy Organ J Date: 2019-01-26 Impact factor: 4.084
Authors: Alexandra M Nanzer; Jaideep Dhariwal; Joanne Kavanagh; Andrew Hearn; Mariana Fernandes; Louise Thomson; Cris Roxas; Linda Green; Grainne D'Ancona; Sangita Agarwal; Brian D Kent; David J Jackson Journal: ERJ Open Res Date: 2020-11-10
Authors: Eugene R Bleecker; Andrew N Menzies-Gow; David B Price; Arnaud Bourdin; Stephen Sweet; Amber L Martin; Marianna Alacqua; Trung N Tran Journal: Am J Respir Crit Care Med Date: 2020-02-01 Impact factor: 21.405