Observational and Pragmatic Research Institute, Singapore, Singapore.
AstraZeneca, Gaithersburg, Maryland.
Allergy. 2019 Feb;74(2):273-283. doi: 10.1111/all.13556. Epub 2018 Nov 20.
Although systemic corticosteroid (SCS) treatment, irrespective of duration or dosage, is associated with adverse outcomes for patients with asthma, the longitudinal effects of this treatment on adverse outcomes, healthcare resource utilization (HCRU), and healthcare costs are unknown.
We identified patients initiating intermittent or long-term SCS who were diagnosed with active asthma from UK general practice with linked secondary care data. Control (non-SCS) patients were matched by sex and index date with those initiating SCS. Minimum baseline period was 1 year prior to index date; minimum follow-up duration was 2 years post-index date. Cumulative incidence of SCS-associated adverse outcomes and associated HCRU and costs were compared between SCS and non-SCS patient groups and among average SCS daily exposure categories. Associations between exposure and annualized HCRU and costs were assessed, adjusted for confounders.
Analyses included 9413 matched pairs. Median (interquartile range) follow up was as follows: SCS group: 7.1 (4.1-11.8) years; control group: 6.4 (3.8-10.0) years. Greater SCS dosages were correlated with greater cumulative incidence. For example, patients with type 2 diabetes receiving an average daily dosage of ≥7.5 mg had a 15-year cumulative incidence (37.5%) that was 1.5-5 times greater than those receiving lower dosages. HCRU and costs increased annually for SCS patients but not for non-SCS patients. Increases in all-cause adverse outcome (excluding asthma)-associated HCRU and costs were dose-dependent.
Over the long term, adverse outcomes associated with SCS initiation were relatively frequent and costly, with a positive dosage-response relationship with SCS exposure.
尽管全身性皮质类固醇（SCS）治疗，无论持续时间或剂量如何，都与哮喘患者的不良结局相关，但这种治疗对不良结局、医疗资源利用（HCRU）和医疗成本的长期影响尚不清楚。
我们从英国普通诊所的哮喘确诊患者中确定了开始接受间歇性或长期 SCS 治疗的患者，并将其与二级护理数据相关联。对照（非 SCS）患者按性别和索引日期与开始 SCS 治疗的患者相匹配。最小基线期为索引日期前 1 年；最小随访期为索引日期后 2 年。比较 SCS 和非 SCS 患者组之间以及平均 SCS 每日暴露类别之间的 SCS 相关不良结局以及相关 HCRU 和成本的累积发生率。在调整混杂因素后，评估暴露与年化 HCRU 和成本之间的关联。
分析包括 9413 对匹配的患者。中位数（四分位距）随访时间如下：SCS 组：7.1（4.1-11.8）年；对照组：6.4（3.8-10.0）年。SCS 剂量越大，累积发生率越高。例如，患有 2 型糖尿病并接受平均每日剂量≥7.5mg 的患者，15 年累积发生率（37.5%）是接受较低剂量患者的 1.5-5 倍。SCS 患者的 HCRU 和成本逐年增加，但非 SCS 患者没有。所有原因不良后果（不包括哮喘）相关 HCRU 和成本的增加与 SCS 暴露呈剂量依赖性。
长期来看，与 SCS 起始相关的不良结局相对频繁且代价高昂，与 SCS 暴露呈正剂量反应关系。
