Groupe d'analyse, Ltée, Montreal, Quebec, Canada.
Analysis Group, Boston, Mass.
J Allergy Clin Immunol. 2015 Dec;136(6):1488-1495. doi: 10.1016/j.jaci.2015.07.046. Epub 2015 Sep 26.
Many patients with severe asthma require maintenance treatment with systemic corticosteroids (SCSs) to control daily symptoms and prevent serious acute exacerbations, but chronic SCS use is associated with complications.
We sought to evaluate the risk of SCS-related complications by SCS exposure and quantify the associated health care costs and resource use in patients with severe asthma.
We performed a longitudinal, open-cohort, observational study using health insurance claims data (1997-2013: Medicaid) from Florida, Iowa, Kansas, Missouri, Mississippi, and New Jersey. Eligible patients were 12 years old or older with 2 or more asthma diagnoses and had more than 6 months of continuous SCS use. An open-cohort approach was used to classify patients' follow-up into low, medium, and high SCS exposure (≤ 6, >6-12, and >12 mg/d, respectively). Multivariate generalized estimating equation models were used to estimate the adjusted risk of SCS-related complications for patients with medium and high exposure compared with patients with low exposure and quantify the resulting health care resource use and costs.
The study included 3628 patients (mean age, 57.6 years; 68% female). Patients with medium and high SCS exposure had significantly higher risks of SCS-related complications, including infections and cardiovascular, metabolic, psychiatric, ocular, gastrointestinal, and bone-related complications (odds ratio, 1.23-2.12 by complication; P < .05 for all but one) versus those with low (reference group) SCS exposure. Medium and high SCS exposure were also associated with significantly more emergency department visits (incidence rate ratios, 1.31 [P = .0004] and 1.78 [P < .0001]) and inpatient visits (incidence rate ratios, 1.25 [P < .0001] and 1.59 [P < .0001]) versus low SCS exposure.
A significant dose-response relationship was demonstrated between chronic SCS use and risk of SCS-related complications in patients with severe asthma. Effective SCS-sparing strategies might reduce the burden associated with SCS-related complications in patients with severe asthma.
许多严重哮喘患者需要使用全身性皮质类固醇（SCS）来维持治疗，以控制日常症状并预防严重的急性加重，但慢性 SCS 使用与并发症有关。
我们旨在评估 SCS 暴露与 SCS 相关并发症风险，并量化严重哮喘患者 SCS 相关并发症的相关医疗保健成本和资源利用。
我们使用来自佛罗里达州、爱荷华州、堪萨斯州、密苏里州、密西西比州和新泽西州的医疗保险索赔数据（1997-2013 年：医疗补助）进行了一项纵向、开放队列、观察性研究。合格患者年龄为 12 岁或以上，有 2 次或更多哮喘诊断，并且 SCS 使用时间超过 6 个月。采用开放队列方法将患者的随访分为低、中、高 SCS 暴露（分别为≤6、>6-12 和>12mg/d）。使用多变量广义估计方程模型来估计中、高暴露患者与低暴露患者相比，SCS 相关并发症的调整风险，并量化由此产生的医疗资源利用和成本。
该研究纳入了 3628 名患者（平均年龄 57.6 岁；68%为女性）。中、高 SCS 暴露的患者发生 SCS 相关并发症的风险显著更高，包括感染和心血管、代谢、精神、眼部、胃肠道和骨骼相关并发症（每种并发症的比值比为 1.23-2.12；除一个外，所有 P 值均<0.05）与低 SCS 暴露（参考组）相比。中、高 SCS 暴露还与急诊就诊（发病率比，1.31[P=0.0004]和 1.78[P<0.0001]）和住院就诊（发病率比，1.25[P<0.0001]和 1.59[P<0.0001]）的发生率显著更高。
在严重哮喘患者中，慢性 SCS 使用与 SCS 相关并发症风险之间存在显著的剂量-反应关系。有效的 SCS 节约策略可能会降低严重哮喘患者与 SCS 相关并发症相关的负担。
