Waljee Akbar K, Rogers Mary A M, Lin Paul, Singal Amit G, Stein Joshua D, Marks Rory M, Ayanian John Z, Nallamothu Brahmajee K
VA Center for Clinical Management Research, Ann Arbor, MI, USA
University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
BMJ. 2017 Apr 12;357:j1415. doi: 10.1136/bmj.j1415.
To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use. Retrospective cohort study and self controlled case series. Nationwide dataset of private insurance claims. Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014. Rates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation. Of 1 548 945 adults, 327 452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001). One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events.
确定口服糖皮质激素短期使用的处方频率及其使用相关的不良事件（败血症、静脉血栓栓塞、骨折）。回顾性队列研究和自我对照病例系列。全国性的私人保险理赔数据集。2012年至2014年持续参保的18至64岁成年人。短期使用口服糖皮质激素定义为疗程少于30天。糖皮质激素使用者和非使用者不良事件的发生率。药物开始使用后30天和31 - 90天风险期内不良事件的发病率比。在1548945名成年人中，327452名（21.1%）在三年期间至少接受了一张口服糖皮质激素短期使用的门诊处方。老年患者、女性和白人成年人的使用更为频繁，存在显著的地区差异（均P<0.001）。最常见的使用指征是上呼吸道感染、脊柱疾病和过敏。处方由多种专科提供。在药物开始使用后的30天内，败血症发生率增加（发病率比5.30，95%置信区间3.80至7.41）、静脉血栓栓塞（3.33，2.78至3.99）和骨折（1.87，1.69至2.07），在随后的31 - 90天内有所下降。在泼尼松等效剂量低于20毫克/天的情况下，增加的风险仍然存在（败血症发病率比4.02，静脉血栓栓塞3.61，骨折1.83；均P<0.001）。在商业保险计划中，五分之一的美国成年人在三年期间接受了口服糖皮质激素短期使用的处方，且不良事件风险相应增加。
