Increased Adverse Event Risk Linked with Long-Term Oral Corticosteroid Use for Eczema

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A somewhat increased adverse event (AE) risk among patients with atopic dermatitis is linked to the implementation of oral corticosteroids for over 90 days per year, according to recent findings, which indicates the necessity of future analyses to fully explore such conclusions.¹

These results were the conclusion of a new analysis conducted in South Korea given the previous overall lack of comprehensive investigations into the risk of AEs with oral corticosteroids, especially among patients with eczema or atopic dermatitis. This research was led by Yong Hyun Jang, MD, from the Kyungpook National University School of Medicine at the Kyungpook National University Hospital in Korea.

“Considering the frequent use of oral corticosteroids among adults with (atopic dermatitis) and the potential association between long-term use of oral corticosteroids and AEs...there is a need to investigate the safety of the long-term use of oral corticosteroids among adults with (atopic dermatitis),” Jang et al wrote. “Accordingly, we aimed to investigate the association between long-term use of oral corticosteroids and AEs among adult patients with (atopic dermatitis) in South Korea.”^1,2

Study Design

The investigators utilized the nationwide Health Insurance Review and Assessment Service (HIRA) database of South Korea, looking at data within the timeframe of January 2012 - October 2021. HIRA included extensive information on healthcare utilization for all residents within South Korea, using anonymized identifiers of patients.

The database itself contains various types of demographic and socioeconomic data. It held information on patients’ diagnoses as well as prescribed medications, with details on days’ supply, medication dosage, national drug chemical codes, dates for prescriptions, and administration routes until either patient emigration or end of life.

The research team’s cohort included individuals who had been prescribed oral corticosteroids at least a single time alongside a diagnosis code for atopic dermatitis between January 2013 - October 2020. The entry date of the cohort was marked by the first oral corticosteroid prescription with a diagnosis of eczema in the study period, looking at newer users of corticosteroids.

Those included among adults with atopic dermatitis who had been given a diagnosis with any of 11 AEs were matched with individuals who had never been diagnosed with any of these AEs. The research team defined long-term oral corticosteroid use as a cumulative supply of over 30 days or over 90 days per year.

The team utilized a multivariable conditional logistic regression analysis for the purposes of evaluating the risk of 11 outcomes, examples of which included fracture, cataract, stroke, osteoporosis, type 2 diabetes, hypertension, hyperlipidemia, myocardial infarction, heart failure, avascular necrosis, or glaucoma. They also adjusted for potential confounding variables.

Conclusions

Overall, there were 1,025,270 subjects with atopic dermatitis assessed between 2013 and 2020, and 164,809 cases were matched with 328,303 controls (mean age 39.4 years with 56.9% being women and 39.3 years with 56.9% being women, respectively). The investigators based the matches on age, sex, follow-up duration, cohort entry date, and severity of eczema.

Of the cases, 3.4% of those in the treatment arm and 3.2% of controls had utilized oral corticosteroids for over 30 days. The research team found that 0.4% of both groups had implemented them for over 90 days.

The team reported that there was not an increased AE risk with the use of corticosteroids for more than 30 days (adjusted odds ratio [AOR], 1.00; 95% CI, 0.97-1.04). However, they did find that there was a slight risk increase seen with utilization past 90 days (AOR, 1.11; 95% CI, 1.01-1.23).

The investigators noted that the aforementioned minor rise in likelihood of reporting AE occurrences in each cumulative or consecutive year of prolonged utilization of corticosteroids.

“Future investigations are warranted to confirm this potential risk of AEs associated with long-term use of oral corticosteroids for patients with exacerbations of (atopic dermatitis), 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,” they wrote.

References

1. ^{Jang YH, Choi E, Lee H, et al. Long-Term Use of Oral Corticosteroids and Safety Outcomes for Patients With Atopic Dermatitis. JAMA Netw Open. 2024;7(7):e2423563. doi:10.1001/jamanetworkopen.2024.23563.}
2. ^{Eckert L, Amand C ,Gadkari A, Rout R, Hudson R, Ardern-Jones M. Treatment patterns in UK adult patients with atopic dermatitis treated with systemic immunosuppressants: data from The Health Improvement Network (THIN). J Dermatolog Treat. 2020;31(8):815-820. doi:10.1080/09546634.2019.1639604.}