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Oral Corticosteroids Increase Risks of Onset of Diabetes Mellitus and Osteoporosis in a UK Patient Population

      SESSION TITLE: Allergy and Asthma
      SESSION TYPE: Original Investigation Poster
      PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM
      PURPOSE: The impacts of dosage and duration of oral corticosteroids (OCS) on chronic disease onset have not been explored in a broad patient population. We studied the association between time-varying measures of OCS exposure and onset of diabetes mellitus (DM) and osteoporosis in patients in the United Kingdom (UK).
      METHODS: A matched historical cohort study was conducted using the Optimum Patient Care Research Database with data from primary care practices within the UK. Patients with ≥2 OCS prescriptions within 18 months were matched 1:1 with those not exposed to systemic corticosteroids on age, sex, and a condition for which OCS may be prescribed. Patients were aged ≥18 years and had ≥3 years of continuous data (≥1 year baseline and ≥2 years outcome period). Index date was the date of first systemic corticosteroid exposure for OCS patients and closest practice visit date for matched non-OCS patients. Separate analyses were conducted for each outcome, excluding patients with respective conditions prior to their index dates. Osteoporosis was defined as a clinical diagnosis or treatment for osteoporosis or a probable osteoporotic fracture. DM was defined as a clinical diagnosis or prescription of anti-diabetic medication or ≥2 HbA1c readings >6.5%. Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI) per 1-gram increase in total cumulative prednisolone-equivalent dose for each outcome.
      RESULTS: 67,626 patients were matched. Mean age was 54.2 years, and 59% were female. OCS was most commonly prescribed for asthma (49.1%) followed by chronic obstructive pulmonary disease (16.8%) and ulcerative colitis (7.8%). 58,069 matched pairs were included in the DM-onset analysis, with a median follow up of 7.0 years for OCS patients and 6.3 years for non-OCS patients. Incidence of DM was greater for OCS compared with non-OCS patients (incidence rate ratio, IRR=1.25 95% CI 1.20, 1.31). Multivariable analyses indicated an increased risk of DM (HR = 1.03 per 1-gram increase in total cumulative OCS dose, 95% CI 1.02, 1.04). For osteoporosis, 56,646 matched pairs were included. OCS and non-OCS patients were followed for a median of 6.6 and 6.2 years respectively. Incidence of osteoporosis was greater for OCS patients (IRR= 2.91 95% CI 2.80, 3.04). Multivariable analyses indicated an increased risk of osteoporosis (HR=1.52 per 1-gram increase in cumulative OCS dose, 95% CI 1.45, 1.60).
      CONCLUSIONS: OCS exposure is associated with increased risk of DM and osteoporosis onset.
      CLINICAL IMPLICATIONS: Longitudinal studies on drug utilization in daily primary care practice are needed to quantify the impact of OCS use on patients’ health.
      DISCLOSURE: David Price: Grant monies (from industry related sources): Conducted the research under contract with AstraZeneca. Frank Trudo: Employee: Full-time employee of AstraZeneca. Joanna Ling Zhi Jie: Grant monies (from industry related sources): Conducted the research under contract with AstraZeneca. Aruni Seneviratna: Grant monies (from industry related sources): Conducted the research under contract with AstraZeneca. Jaco Voorham: Grant monies (from industry related sources): Conducted the research under contract with AstraZeneca. Marjan Kerkhof: Grant monies (from industry related sources): Conducted the research under contract with AstraZeneca. Xiao Xu: Employee: Full-time employee of AstraZeneca. Jill Davis: Employee: Full-time employee of AstraZeneca. Trung Tran: Employee: Full-time employee of AstraZeneca.
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