Tran Trung N, Heatley Heath, Rowell Jennifer, Chan Jeffrey Shi Kai, Bourdin Arnaud, Chapaneri Jatin, Emmanuel Benjamin, Gibson Danny, Jackson David J, Menzies-Gow Andrew N, Murray Ruth, Skinner Derek, Price David B
BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md.
Observational and Pragmatic Research Institute, Singapore.
J Allergy Clin Immunol Glob. 2024 Feb 2;3(2):100225. doi: 10.1016/j.jacig.2024.100225. eCollection 2024 May.
Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes.
We sought to describe the evolution and trajectory of intermittent OCS prescription patterns in patients with asthma and investigate risk factors independently associated with transitioning to a frequent prescription pattern.
This historical cohort study included patients with active asthma managed in UK primary care and included in the Optimum Patient Care Research Database (OPCRD; opcrd.co.uk). Intermittent OCS prescription patterns were categorized as sporadic, infrequent, moderately frequent, or frequent. Prescription pattern sequences were described for those who had a frequent sequence in their final year of prescribing. We examined associations between OCS prescription pattern and the hazard of transitioning into a frequent intermittent OCS prescription pattern using multivariable Cox regression with a 10-year look-back period.
Of 105,229 patients with intermittent OCS prescriptions, 57.1% (n = 60,083) had a frequent OCS prescription pattern at some point. Irrespective of baseline pattern, most patients transitioned to frequent prescription during the look back. The strongest risk factors were a more frequent prescription pattern at the start of look-back period, a lower percentage peak expiratory flow rate, and higher Global Initiative for Asthma treatment step. Older age, female sex, obesity, and active smoking were also associated with a higher risk of transitioning.
Our findings help identify those most at risk of transitioning to frequent intermittent OCS receipt and encourage earlier intervention with OCS-sparing treatments.
间歇性口服糖皮质激素（OCS）处方频率增加以及OCS累积暴露会增加与OCS相关不良结局的风险。
我们试图描述哮喘患者间歇性OCS处方模式的演变和轨迹，并调查与转变为频繁处方模式独立相关的风险因素。
这项历史性队列研究纳入了在英国初级医疗中接受管理且纳入最佳患者护理研究数据库（OPCRD；opcrd.co.uk）的活动性哮喘患者。间歇性OCS处方模式分为偶发、不频繁、中度频繁或频繁。描述了在最后一年处方中有频繁模式序列的患者的处方模式序列。我们使用具有10年回顾期的多变量Cox回归分析了OCS处方模式与转变为频繁间歇性OCS处方模式风险之间的关联。
在105,229例有间歇性OCS处方的患者中，57.1%（n = 60,083）在某些时候有频繁的OCS处方模式。无论基线模式如何，大多数患者在回顾期间转变为频繁处方。最强的风险因素是回顾期开始时更频繁的处方模式、较低的呼气峰值流速百分比以及较高的全球哮喘防治创议治疗级别。年龄较大、女性、肥胖和当前吸烟也与转变风险较高相关。
我们的研究结果有助于识别那些最有可能转变为频繁接受间歇性OCS治疗的患者，并鼓励更早地采用减少OCS使用的治疗方法进行干预。
