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Mohsen Sadatsafavi
University of British Columbia Faculty of Pharmaceutical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0419-7862
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Background: Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort.
Methods: We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression.
Results: 21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p<0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p<0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis.
Conclusions: This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.
Keywords
Asthma, Asthma/*drug therapy, Drug Prescriptions/*statistics & numerical data, Corticosteroids, Cohort Studies
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CURRENT STATUS: Published
View the published article at Respiratory Research.
No community comments so far
Reviewer #2 agreed
On 06 Feb, 2021
Review #2 received
Received 06 Feb, 2021
Editorial decision: Minor revision
On 06 Feb, 2021
Review #1 received
Received 28 Dec, 2020
Reviewer #1 agreed
On 29 Nov, 2020
Reviewers invited
Invitations sent on 25 Nov, 2020
Editor assigned
On 17 Nov, 2020
Submission checks complete
On 17 Nov, 2020
Editor invited
On 17 Nov, 2020
Version 1
Posted 07 Jul, 2020
No comments provided
Reviewer #1 agreed
On 19 Oct, 2020
Review #1 received
Received 19 Oct, 2020
Editorial decision: Major revision
On 19 Oct, 2020
Reviewers invited
Invitations sent on 13 Jul, 2020
Editor assigned
On 03 Jul, 2020
First submitted
On 02 Jul, 2020
Submission checks complete
On 02 Jul, 2020
Editor invited
On 02 Jul, 2020
Metrics
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PDF Downloads: ...
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Subject Areas
Pulmonology
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A new preprint design is coming!
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See the published version of this preprint at Respiratory Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Mohsen Sadatsafavi
University of British Columbia Faculty of Pharmaceutical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0419-7862
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Respiratory Research.
No community comments so far
Reviewer #2 agreed
On 06 Feb, 2021
Review #2 received
Received 06 Feb, 2021
Editorial decision: Minor revision
On 06 Feb, 2021
Review #1 received
Received 28 Dec, 2020
Reviewer #1 agreed
On 29 Nov, 2020
Reviewers invited
Invitations sent on 25 Nov, 2020
Editor assigned
On 17 Nov, 2020
Submission checks complete
On 17 Nov, 2020
Editor invited
On 17 Nov, 2020
Version 1
Posted 07 Jul, 2020
No comments provided
Reviewer #1 agreed
On 19 Oct, 2020
Review #1 received
Received 19 Oct, 2020
Editorial decision: Major revision
On 19 Oct, 2020
Reviewers invited
Invitations sent on 13 Jul, 2020
Editor assigned
On 03 Jul, 2020
First submitted
On 02 Jul, 2020
Submission checks complete
On 02 Jul, 2020
Editor invited
On 02 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Respiratory Research.
Background: Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort.
Methods: We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression.
Results: 21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p<0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p<0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis.
Conclusions: This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.
Figure 1
Figure 2
The full text of this article is available to read as a PDF.
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