Dose-dependent association between inhaled corticosteroids and risk of corticosteroid related adverse events in asthma

<bold>Background:</bold> The link between use of oral corticosteroids (OCS) and serious adverse events (SAEs) in asthma is well-described. In contrast, whether use of high-dose inhaled corticosteroids (ICS) has a risk on these is not clear. <bold>Aim:</bold> Using Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort we examined whether current high-dose ICS exposure is associated with incident CS-related SAEs <bold>Methods:</bold> This was an observational cohort study including asthma patients ≥18 years between 2009-19. We used Cox regression models to examine the association between current ICS exposure (daily µg budesonide as a time-dependent predictor) and CS-related SAEs including osteoporosis, type-2 diabetes (T2D), cataract and pneumonia with patients using no ICS as reference. Age, sex, and OCS dose were included as covariates. <bold>Results:</bold> Overall, 529,203 asthma patients were included. We found a dose-response association between SAEs and increasing daily ICS doses. HRs of osteoporosis increased if ICS dose >800 µg: HR 1.23 (95%CI 1.16-1.30) if 800-1599 µg and HR 1.4 (95%CI 1.24-1.58) with >2400µg per day. T2D HR increased from 1.11 (95%CI 1.06-1.16) if 800-1599µg to HR 1.58 (95%CI 1.42-1.77) with >2400µg daily. Likewise, cataract risk increased with higher ICS doses. Lastly, pneumonia risk increased from HR 1.65 (95%CI 1.58-1.72) to 2.91 (95%CI 2.68-3.16) if dose increased from 800-1599 to >2400µg. <bold>Conclusion:</bold> We identified a dose-dependent added risk of current high-dose ICS use on several CS-related SAEs. This highlights the importance for clinicians to consider this risk in patients treated with high-dose ICS. More studies are needed to further investigate this association.

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Published
2024-09-14
DOI
https://doi.org/10.1183/13993003.congress-2024.oa3763
Primary Topic
Asthma and respiratory diseases
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article
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article

Dose-dependent association between inhaled corticosteroids and risk of corticosteroid related adverse events in asthma

Asger Sverrild, Arja Viinanen, Anna von Bülow, Olivia Ernstsson et al.
Asthma and respiratory diseases
article

Dose-dependent association between inhaled corticosteroids and risk of corticosteroid related adverse events in asthma

Asger Sverrild, Arja Viinanen, Anna von Bülow, Olivia Ernstsson, Patrik Sandin, Helena Bäckman, Christer Janson, Jussi Karjalainen, Hannu Kankaanranta, Alan Altraja, Pinja Ilmarinen, Paula Kauppi, Susanne Hansen, Charlotte Suppli Ulrik, Ghada F. R. Hassan, Valentyna Yasinska, Apostolos Bossios Bossios, Kirk Geale, Celeste Porsbjerg, Lauri Lehtimäki, Vibeke Backer, Alexandra Cooper, Bernt Bøgvald Aarli, Maritta Kilpeläinen, Sylvia Packham
article en

Abstract

<bold>Background:</bold> The link between use of oral corticosteroids (OCS) and serious adverse events (SAEs) in asthma is well-described. In contrast, whether use of high-dose inhaled corticosteroids (ICS) has a risk on these is not clear. <bold>Aim:</bold> Using Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort we examined whether current high-dose ICS exposure is associated with incident CS-related SAEs <bold>Methods:</bold> This was an observational cohort study including asthma patients ≥18 years between 2009-19. We used Cox regression models to examine the association between current ICS exposure (daily µg budesonide as a time-dependent predictor) and CS-related SAEs including osteoporosis, type-2 diabetes (T2D), cataract and pneumonia with patients using no ICS as reference. Age, sex, and OCS dose were included as covariates. <bold>Results:</bold> Overall, 529,203 asthma patients were included. We found a dose-response association between SAEs and increasing daily ICS doses. HRs of osteoporosis increased if ICS dose >800 µg: HR 1.23 (95%CI 1.16-1.30) if 800-1599 µg and HR 1.4 (95%CI 1.24-1.58) with >2400µg per day. T2D HR increased from 1.11 (95%CI 1.06-1.16) if 800-1599µg to HR 1.58 (95%CI 1.42-1.77) with >2400µg daily. Likewise, cataract risk increased with higher ICS doses. Lastly, pneumonia risk increased from HR 1.65 (95%CI 1.58-1.72) to 2.91 (95%CI 2.68-3.16) if dose increased from 800-1599 to >2400µg. <bold>Conclusion:</bold> We identified a dose-dependent added risk of current high-dose ICS use on several CS-related SAEs. This highlights the importance for clinicians to consider this risk in patients treated with high-dose ICS. More studies are needed to further investigate this association.

Uppsala University (SE), Statistics Sweden (SE), Karolinska University Hospital (SE), University of Helsinki (FI), Uppsala University Hospital (SE), Seinäjoki University of Applied Sciences (FI), Helsinki University Hospital (FI), Haukeland University Hospital (NO), Frederiksberg Hospital (DK), Bispebjerg Hospital (DK), Hvidovre Hospital (DK), Turku University Hospital (FI), Tartu University Hospital (EE), Rigshospitalet (DK), Karolinska Institutet (SE), Sanofi (Finland) (FI), 358 (Finland) (FI), Tampere University Hospital (FI), Tampere University (FI), Quantify Research (Sweden) (SE), Umeå University (SE)
Good health and well-being
Openalex Percentile: Top 72%
Asthma and respiratory diseases
DOISourceOpenAlex
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