Oral corticosteroid overexposure: characterizing oral corticosteroid use in patients with chronic rhinosinusitis with nasal polypS in Canada (ACTIONS) results.

Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory condition, often treated with oral corticosteroids (OCS). OCS overexposure can increase the risk of adverse effects, highlighting the need for better treatment strategies including timely biologic therapy use. This study explored OCS use patterns in patients with severe CRSwNP in Canada pre-biologic initiation.

Methods: This retrospective, real-world study used IQVIA's Private Drug Plan (PDP) claims database to examine OCS use patterns 0-24 months pre-initiation of biologic therapy in patients with inferred CRSwNP in Canada (n = 747). Outcomes included OCS use patterns (proportions, claims per patient and by prescribing physician specialty, overexposure [≥ 1000 mg annually, prednisone-equivalent]), demographics, and stratified by comorbid asthma.

Results: Of 747 patients indexed from the PDP, 81.0% had ≥ 1 OCS claim(s), with a median (interquartile range [IQR]) of 3.0 (4.0) claims per patient. Median (IQR) total OCS dose over 24 months was 1020 (1420) mg; 41.5% of patients experienced OCS overexposure. OCS was primarily prescribed by general practitioners (35.9%) and otolaryngologists (32.8%). Patients had a median (IQR) age of 51 (18) years at index, 52.1% were male, and most were from Ontario (48.7%). OCS use was highest in patients with comorbid severe asthma.

Conclusions: This study highlights OCS overexposure in patients with CRSwNP pre-biologic initiation. Enhancing physician and patient awareness of appropriate OCS use and timely biologic initiation could reduce the risk of OCS-related adverse effects and improve CRSwNP management, benefiting long-term patient outcomes through shared decision-making. Trial registration GSK study number 221872.