Long-term maintenance systemic corticosteroid-related complications quantified in patients with severe asthma


Published Online: September 20, 2015

Severe asthma affects up to 10% of the entire asthma population and is associated with high morbidity and costs. In 30% to 40% of patients, maintenance treatment with systemic corticosteroids (SCS) are required to control daily symptoms and prevent serious exacerbations, however the use of SCSs is associated with short- and long-term complications.

In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Lefebvre and colleagues evaluated the dose-response relationship between SCS exposure and the risk of developing SCS-related complications in a severe asthma population, and quantified the healthcare resource use and cost burden associated with these complications. Using medical and pharmacy claims from Medicaid beneficiaries over a period of 15 years (1997-2013), they identified 3,628 patients with severe asthma receiving SCS, and classified their level of cumulative exposure (low: ≤6mg/day, medium: >6-12mg/day, or high: >12mg/day) over time to estimate the adjusted risk of developing SCS-related complications and quantify the resulting healthcare resource use and costs by level of SCS exposure.

The results showed that patients with medium and high SCS exposure had significantly higher risks of developing SCS-related complications including infections, cardiovascular, metabolic, psychiatric, ocular, gastrointestinal, and bone-related (odds ratios 1.23-2.12 by complication; all but one had p<0.05) versus those with low (reference group) SCS exposure. Medium and high SCS exposure were also associated with significantly more emergency room and inpatient visits, versus low SCS exposure. The study also reported that annual per patient costs associated with SCS-related complications for medium and high exposure were respectively $1,914 and $5,479 higher than those of patients with low SCS exposure.

This study presents evidence of a significant dose-response relationship between the chronic use of systemic corticosteroids and the risk of developing associated complications in patients with severe asthma, highlighting the associated healthcare resource utilization and cost burden. These results advocate pursuing efforts to develop SCS-sparing strategies for severe asthma patients.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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