Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom
Background: Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes. Objective: We sought to describe the evolution and trajectory of intermittent OCS prescription patterns in patients with asthma and i...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829324000213 |
| _version_ | 1827258477670563840 |
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| author | Trung N. Tran, MD, PhD Heath Heatley, PhD Jennifer Rowell, MSc Jeffrey Shi Kai Chan, MBChB, MPH Arnaud Bourdin, MD, PhD Jatin Chapaneri, MD Benjamin Emmanuel, PhD Danny Gibson, MSc David J. Jackson, MRCP Andrew N. Menzies-Gow, FRCPi Ruth Murray, PhD Derek Skinner, MSc David B. Price, FRCGP |
| author_facet | Trung N. Tran, MD, PhD Heath Heatley, PhD Jennifer Rowell, MSc Jeffrey Shi Kai Chan, MBChB, MPH Arnaud Bourdin, MD, PhD Jatin Chapaneri, MD Benjamin Emmanuel, PhD Danny Gibson, MSc David J. Jackson, MRCP Andrew N. Menzies-Gow, FRCPi Ruth Murray, PhD Derek Skinner, MSc David B. Price, FRCGP |
| author_sort | Trung N. Tran, MD, PhD |
| collection | DOAJ |
| description | Background: Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes. Objective: 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. Methods: 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. Results: 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. Conclusion: Our findings help identify those most at risk of transitioning to frequent intermittent OCS receipt and encourage earlier intervention with OCS-sparing treatments. |
| first_indexed | 2024-04-24T23:12:53Z |
| format | Article |
| id | doaj.art-a6b326d0480546b0b054b4170e457828 |
| institution | Directory Open Access Journal |
| issn | 2772-8293 |
| language | English |
| last_indexed | 2025-03-22T02:11:19Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj.art-a6b326d0480546b0b054b4170e4578282024-05-07T04:06:43ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932024-05-0132100225Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United KingdomTrung N. Tran, MD, PhD0Heath Heatley, PhD1Jennifer Rowell, MSc2Jeffrey Shi Kai Chan, MBChB, MPH3Arnaud Bourdin, MD, PhD4Jatin Chapaneri, MD5Benjamin Emmanuel, PhD6Danny Gibson, MSc7David J. Jackson, MRCP8Andrew N. Menzies-Gow, FRCPi9Ruth Murray, PhD10Derek Skinner, MSc11David B. Price, FRCGP12BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MdObservational and Pragmatic Research Institute, SingaporeAstraZeneca, Cambridge, United KingdomBioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MdDepartment of Respiratory Diseases, PhyMedExp, University of Montpellier, Montpellier, FranceAstraZeneca, Cambridge, United KingdomBioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MdAstraZeneca, Cambridge, United KingdomGuy’s and St Thomas’ NHS Trust and School of Immunology & Microbial Sciences, King’s College, London, United KingdomUK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals and School of Immunology & Microbial Sciences, King’s College, London, United Kingdom; Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United KingdomOptimum Patient Care, Cambridge, United KingdomObservational and Pragmatic Research Institute, SingaporeObservational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom; Corresponding author: David B. Price, FRCGP, Observational and Pragmatic Research Institute, 22 Sin Ming Ln, #06-76, Midview City, Singapore 573969.Background: Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes. Objective: 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. Methods: 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. Results: 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. Conclusion: Our findings help identify those most at risk of transitioning to frequent intermittent OCS receipt and encourage earlier intervention with OCS-sparing treatments.http://www.sciencedirect.com/science/article/pii/S2772829324000213OCSintermittentasthmariskprescription |
| spellingShingle | Trung N. Tran, MD, PhD Heath Heatley, PhD Jennifer Rowell, MSc Jeffrey Shi Kai Chan, MBChB, MPH Arnaud Bourdin, MD, PhD Jatin Chapaneri, MD Benjamin Emmanuel, PhD Danny Gibson, MSc David J. Jackson, MRCP Andrew N. Menzies-Gow, FRCPi Ruth Murray, PhD Derek Skinner, MSc David B. Price, FRCGP Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom Journal of Allergy and Clinical Immunology: Global OCS intermittent asthma risk prescription |
| title | Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom |
| title_full | Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom |
| title_fullStr | Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom |
| title_full_unstemmed | Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom |
| title_short | Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom |
| title_sort | longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the united kingdom |
| topic | OCS intermittent asthma risk prescription |
| url | http://www.sciencedirect.com/science/article/pii/S2772829324000213 |
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