Dermatology
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Atopy
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Over 90 days of exposure linked to adverse events
by
Elizabeth Short,
Staff Writer, MedPage Today,
July 19, 2024
Prolonged use of oral corticosteroids in adults with atopic dermatitis (AD) was associated with a slight uptick in adverse events (AEs), a nested case-control study showed.
Based on a million individuals with AD in South Korea, those who experienced AEs were more likely to have been using oral corticosteroids for longer than 90 days compared with matched controls (adjusted OR 1.11, 95% CI 1.01-1.23) — and every additional year of exposure beyond that was further associated with a small increase in the risk, reported Ju-Young Shin, PhD, of Sungkyunkwan University in Suwon, South Korea, and co-authors.
In contrast, the risk associated with exposure to oral corticosteroids for more than 30 days was not significant (adjusted OR 1.00, 95% CI 0.97-1.04), according to the case-control study published in JAMA Network Open .
“Future investigations are warranted to confirm this potential risk of AEs associated with long-term use of oral corticosteroids for patients with exacerbations of AD, and health care professionals should thoroughly weigh the benefits associated with oral corticosteroids against the observed small risk of AEs, while continuously monitoring for AEs,” Shin’s group wrote.
The 11 AEs counted in the study were osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataract, and glaucoma.
AD, also known as eczema, is a fairly common inflammatory skin disease. Although no cure exists, the condition may be addressed by a variety of interventions for moisturizing and itch control. Up to 10% of adult patients require phototherapy or systemic therapy to manage their moderate or severe AD when topical treatments fall short. Many dermatologists resort to oral corticosteroids for acute flares, but long-term use of the drugs has been linked to negative health impacts when examined among patients with asthma and rheumatic disease.
Indeed, Susan Massick, MD, of the Ohio State University Wexner Medical Center in Columbus, told MedPage Today via email that the findings of the present study were not surprising and in line with the asthma literature.
“This study won’t change the conversations dermatologists are having with their patients, but it is a useful reminder that you, as the prescribing physician, should always review the benefits and risks of any medication, no matter how long the medicine has been in use, or even if the person has been on the medication before. Whether short-term course or more prolonged use, informing patients about these known potential side effects and risks is warranted,” she said.
David Reid, MD, of Rush University Medical Center in Chicago, echoed these sentiments to MedPage Today via email.
“Corticosteroids have broad effects on a number of the body’s physiological systems, including the immune system, metabolic system, and hormone system,” he said. “Their wide-ranging effects can be beneficial in suppressing inflammation, but because they impact the body’s systems in such an expansive way, they also can result in disruptions that appear in the form of adverse effects.”
Reid also noted that these findings can “guide conversations about corticosteroids versus other newer treatment options, which in many cases are more targeted, and therefore often carry less potential risk.”
In 2021, the JAK inhibitor ruxolitinib (Opzelura) was approved for short-term topic treatment in adults and teenagers with mild to moderate AD. Other eczema indications for oral JAK inhibitors abrocitinib (Cibinqo) and upadacitinib (Rinvoq) were approved soon afterward.
For the present analysis, Shin’s group relied on the Health Insurance Review and Assessment Service database of South Korea and identified 1,025,270 patients with AD. Patients were excluded if they had a diagnosis of any immune-mediated inflammatory diseases during the year-long window prior to the cohort entry date, a diagnosis of any of the 11 outcomes of interest within a year prior and after the cohort entry date, and if the patients were younger than age 18 years at the time of cohort entry.
People diagnosed with any of the 11 AEs (n=164,809) were matched with controls who had never received such diagnoses (n=328,303). Mean age was around 39.4 years, and both groups were nearly 57% women.
Study authors found that 3.4% of participants with AD and 3.2% of control participants had been using oral corticosteroids for more than 30 days, whereas 0.4% of AD cases and 0.4% of control patients had been exposed to oral corticosteroids for more than 90 days.
Comorbidities common to both groups were allergic rhinitis, chronic sinusitis, conjunctivitis, anxiety, depression, chronic obstructive pulmonary disease, chronic liver disease, and thyroid disorders.
People with greater than 30 days of oral corticosteroid use were at significantly increased risk of the individual outcomes of:
Hypertension (adjusted OR 1.09, 95% CI 1.03-1.15) Avascular necrosis (adjusted OR 2.56, 95% CI 1.82-3.62) Cataracts (adjusted OR 3.22, 95% CI 1.05-9.85)
Meanwhile, oral corticosteroid use for more than 90 days was tied to:
Fracture (adjusted OR 1.22, 95% CI 1.05-1.42) Hyperlipidemia (adjusted OR 1.16, 95% CI 1.03-1.30) Myocardial infarction (adjusted OR 2.22, 95% CI 1.17-4.22) Avascular necrosis (adjusted OR 6.88, 95% CI 3.53-13.42)
Shin and colleagues acknowledged that they could not rule out reverse causality, given the nature of their retrospective case-control design.
As for other study limitations, researchers said there were disparities within the database between recorded diagnoses and the disease a patient actually had, and their database did not explicitly include clinical information related to AD. Additionally, topical and eye drop corticosteroids were not studied.
Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Disclosures
This study was supported by funding from Pfizer Pharmaceuticals Korea.
Shin reported grants from the Ministry of Food and Drug Safety, Ministry of Health and Welfare, National Research Foundation of Korea, Celltrion, and SK Bioscience.
Massick and Reid reported no disclosures.
Primary Source
JAMA Network Open
Source Reference: Jang YH, et al “Long-term use of oral corticosteroids and safety outcomes for patients with atopic dermatitis” JAMA Netw Open 2024; DOI:10.1001/jamanetworkopen.2024.23563.
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