Long-term oral glucocorticoid use is associated with complications, healthcare resource utilization, and costs among patients with dermatomyositis or polymyositis.

Abstract

Introduction/objective: Oral glucocorticoids (OGC) are conventionally used as first-line treatment for dermatomyositis (DM) and polymyositis (PM). This study evaluated clinical and economic outcomes associated with long-term (LT) OGC use in DM/PM.

Methods: Adults with ≥ 2 medical claims of DM/PM 30‒365 days apart from January 1, 2016, to December 31, 2022, and ≥ 1 diagnosis code of a physician specialty of interest were selected from the MarketScan Commercial and Medicare Supplemental databases. Patients should have ≥ 1 OGC pharmacy claim (i.e., date of first claim defined as index date) on or after the diagnosis date, ≥ 12 months pre- and post-index continuous enrollment, and no diagnosis of inclusion body myositis during the study. The LT group included patients with continuous OGC use for ≥ 3 consecutive months within the 12-month post-index period, whereas short-term (ST) users included those with < 3 consecutive months of OGC use.

Results: Two thousand two-hundred eighty patients were included (LT, 1313 [57.6%]; ST, 967 [42.4%]). Compared with ST, LT OGC patients had significantly higher incidences of OGC-related complications, such as heart failure (adjusted odds ratio [aOR], 1.8; 95% CI, 1.3‒2.7) and osteoporosis (aOR, 1.9; 95% CI, 1.4‒2.6), after covariate adjustment. LT users had increased odds for both all-cause (aOR, 1.7; 95% CI, 1.3‒2.2) and disease-related inpatient admission (aOR, 3.8; 95% CI, 2.3‒6.2) versus ST users. Higher adjusted average annual all-cause (by US $30,555; p < 0.01) and disease-related costs (by US $21,311; p < 0.01) were incurred by LT versus ST users.

Conclusions: DM/PM patients with LT OGC use had higher rates of associated medical conditions and higher healthcare resource utilization and costs than ST users. Key points • Long-term use of oral glucocorticoids (OGC) in patients with dermatomyositis (DM) and polymyositis (PM) is associated with increased risk of complications, and there is limited real-world evidence on the association of long-term use with clinical and economic outcomes. • This real-world claims-based study demonstrated that long-term OGC use in patients with DM/PM leads to higher rates of complications, advanced treatment use and healthcare resource utilization, and higher costs compared with short-term OGC use. • These findings highlight the limitations of OGC as a therapeutic tool and further support an unmet medical need for new treatment options among patients with DM/PM. • Disease management with novel treatments that have an advantageous safety profile and can be utilized any time throughout the disease course may provide safer, more efficacious alternatives to OGC.