Prolonged Oral Corticosteroid Use Slightly Increases Adverse Event Risk in Atopic Dermatitis Patients: JAMA

Oral corticosteroids are commonly indicated for the treatment of chronic inflammatory disorders, such as atopic dermatitis. However, therapy with these drugs for extended periods has been associated with a wide range of adverse events. In spite of this, there is a paucity of large studies of good design examining the risks associated with long-term oral corticosteroid use in patients with AD. This study aims to fill this knowledge gap by assessing the association of prolonged corticosteroid exposure with the development of specific AEs in adults with AD.

This was a nested case-control study with data obtained from the Health Insurance Review and Assessment Service database of South Korea, covering the period of 1 January 2012 to 31 October 2021. In this study, adult patients with AD were included in the cohort where data one year before and after the study period were made available for sufficient assessment of the exposure.Cases were defined as patients diagnosed with any of 11 AEs, and they were matched to controls that never were diagnosed with these AEs.

Long-term oral corticosteroid use was defined as one having received a cumulative supply of more than 30 days or more than 90 days per year. Primary outcomes included 11 single adverse events: osteoporosis, fractures, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataracts, and glaucoma. The multivariable conditional logistic regression analyses assessed the risk of these outcomes.

The key findings of the study were:

• The study analyzed 1,025,270 AD patients from 2013 to 2020.

• Among these, 164,809 cases (mean age 39.4 years; 56.9% women) were matched with 328,303 controls (mean age 39.3 years; 56.9% women) based on sex, age, cohort entry date, follow-up duration, and AD severity.

• Exposures to oral corticosteroids for more than 30 days were reported in 5,533 cases (3.4%) and 10,561 controls (3.2%), while exposures for more than 90 days were reported in 684 cases (0.4%) and 1,153 controls (0.4%).

• This analysis did not show an increased risk for AEs with oral corticosteroid use for more than 30 days: AOR, 1.00; 95% CI, 0.97-1.04.

• There was, however, a slightly increased risk with use longer than 90 days: AOR 1.11; 95% CI, 1.01-1.23.

• This small absolute increase in AE risk was consistent with each cumulative or consecutive year of long-term use.

This study indicates that long-term oral corticosteroid use slightly increases the risk of the onset of adverse events in adults with AD, mainly when administration is administered beyond 90 days a year. Worth highlighting at this point is the extra careful mode of prescription and monitoring of patients under long-term corticosteroid therapy. Generally, the risk is small but large enough to be important, especially in those requiring longer treatment.

This study demonstrated a slight increased risk of adverse events associated with the long-term use of oral corticosteroids in adults with atopic dermatitis. The findings also give weight to careful management and monitoring of corticosteroid therapy for patient safety and optimal treatment outcomes.

Reference:

Jang, Y. H., Choi, E.-Y., Lee, H., Woo, J., Park, S., Noh, Y., Jeon, J.-Y., Yoo, E.-Y., Shin, J.-Y., & Lee, Y. W. (2024). Long-term use of oral corticosteroids and safety outcomes for patients with atopic dermatitis. JAMA Network Open, 7(7), e2423563. https://doi.org/10.1001/jamanetworkopen.2024.23563