High incidence of oral corticosteroids prescriptions in children with asthma in early childhood

Abstract

Objective: Severe asthma exacerbations are often treated with short courses of oral corticosteroids (OCS). This study assessed the incidence of OCS being prescribed in asthmatic children of various age groups and calculated their chances of receiving subsequent OCS prescriptions. Methods: Longitudinal Dutch community pharmacy data of 2272 children who were regular users of asthma medication was analyzed retrospectively. Incidence rates for first, second and third prescriptions of OCS were calculated, stratified by age and sex. Probabilities of receiving first, second or third OCS prescriptions were assessed with Kaplan–Meier analysis. Results: Incidence rates for first OCS prescriptions were 4.5 for the 1^st year of life per 100 person-years (100PY); 3.9 for the 2^nd; 4.6 for the 3^rd; 4.2 for the 4^th, and 4.7 for the 5^th year of life per 100PY. This was relatively high compared to incidence rates for children between the ages of 6 and 11 (ranging between 2.2 per 100PY (age 9) and 3.7(age 11)). Incidence rates for second and third OCS prescriptions were very high: 78.2(95%CI: 45.0–123.7) and 241.2(95%CI: 81.2–583.4) per 100PY for infants, respectively. The chances of receiving a first OCS prescription was higher in males (P value < 0.01). Conclusions: In the Netherlands, the incidence of OCS being prescribed to children being treated with asthma medication in early childhood is relatively high for first OCS prescriptions and extremely high for second and third OCS prescriptions compared to other ages. Furthermore, there is a high probability of receiving a further OCS prescription shortly after an OCS prescription.

Keywords:

• Asthma
• exacerbation
• incidence
• longitudinal
• oral corticosteroid
• OCS
• treatment

Declaration of interest

Jan A. M. Raaijmakers is a part-time professor at the Utrecht University and he was Vice-president External Scientific Collaborations for GSK in Europe, and holds stock in GSK. Cornelis K. van der Ent received unrestricted grants from GSK and Grunenthal. Furthermore, the Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, employing authors Ali Arabkhazaeli, Susanne J.H. Vijverberg, Jan A.M. Raaijmakers, and Anke-Hilse Maitland-van der Zee, has received unrestricted research funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the private-public funded Top Institute Pharma (http://www.tipharma.nl website, includes co-funding from universities, government, and industry), the EU Innovative Medicines Initiative (IMI), EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board, the Dutch Ministry of Health and industry (including GSK, Pfizer, and others). The authors alone are responsible for the content and writing of the article.

Funding

The PACMAN cohort study has been funded by a strategic alliance between the Utrecht Institute for Pharmaceutical Sciences (UIPS) and GlaxoSmithKline (GSK).