Use of high-dose inhaled corticosteroids and risk of corticosteroid related adverse events in asthma -findings from the NORDSTAR cohort.

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-02-01 DOI:10.1016/j.jaip.2025.01.023

Anna von Bülow, Susanne Hansen, Patrik Sandin, Alexandra Cooper, Olivia Ernstsson, Kirk Geale, Lauri Lehtimäki, Charlotte Ulrik, Bernt Bøgvald Aarli, Pinja Ilmarinen, Sylvia Packham, Ghada Hassan, Asger Sverrild, Helena Backman, Jussi Karjalainen, Vibeke Backer, Alan Altraja, Paula Kauppi, Valentina Yasinska, Maritta Kilpeläinen, Arja Viinanen, Johannes Martin-Schmid, Apostolos Bossios, Celeste Porsbjerg, Hannu Kankaanranta, Christer Janson

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引用次数: 0

Abstract

Background: The link between the use of oral corticosteroids (OCS) and adverse events (AEs) in asthma is well-described. In contrast, whether the use of high-dose inhaled corticosteroids (ICS) poses a risk to these is unknown.

Objective: To examine the association between ICS exposure and corticosteroid-related AEs.

Methods: We conducted an observational cohort study using nationwide Swedish registry data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration. We included asthma patients ≥18 years between 2009 and 2019 and calculated their current ICS exposure and average daily ICS dose (budesonide eq.) in follow-up. The association between ICS exposure and CS-related AEs was analyzed using Cox proportional hazards models adjusting for age, sex, and OCS dose.

Results: We included 529,203 asthma patients. Overall, we observed increased hazard ratios (HR) in those exposed to high-dose (≥800-1599 μg) and very-high-dose (≥1600μg) ICS for several AEs, including cardiovascular disease, T2DM, osteoporosis and pneumonia compared to no ICS use. HRs for the current use of high-dose ICS ranged from 1.11 (95%CI 1.06-1.16) for T2DM to 1.65 (95%CI 1.58-1.72) for pneumonia. Likewise, HRs linked to average daily high-dose ICS ranged from 1.16 (95%CI 1.02-1.33) for pneumonia to 1.70 (95%CI 1.38-2.08) for osteoporosis. Sensitivity analysis excluding patients using OCS showed that high-dose ICS still associated with an increased risk of CS-related AEs. Overall, ICS <800 μg/daily had no increased risk, except for cataract.

Conclusion: High-dose ICS is associated with an increased risk of several corticosteroid-related AEs. This highlights the importance of clinicians considering this risk in patients treated with high and very high-dose ICS.

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.