A systematic review of the adverse events and economic impact associated with oral corticosteroids in asthma

Abstract

Background: Oral corticosteroids (OCSs) are often used to achieve asthma control. OCS-related comorbidities increase the burden of disease for patients and healthcare providers. Most studies characterizing OCS use and risk of adverse events (AEs) are in non-asthma patients. We sought to systematically review the literature on the burden of OCS use among adults with asthma. Methods: We systematically reviewed the literature including MEDLINE (1946–May 2017), EMBASE (1974–May 2017), and the Cochrane Library (2005–May 2017) to identify studies that considered AEs due to OCS treatment of adults with asthma, their burden on healthcare utilization, and costs. Results: We retrieved 9,589 citations; and 15 studies were included. AEs were significantly higher among OCS-users compared with non-OCS users with pooled adjusted odds ratio (OR) 1.68 (95% CI 1.15–2.46) for diabetes mellitus and 1.34 (95% CI 1.23–1.46) for hypertension. Among high dose OCS-users (>10 mg) compared with non-OCS users, the pooled adjusted ORs for development of any complication was 3.35 (95% CI 2.94–3.82), and bone and muscle complications 2.30 (95% CI 2.18–2.42). The risk of any complication increased with higher doses of OCS, with pooled adjusted OR from 2 studies of 2.26 (95% CI 1.37–3.72), 2.94 (95% CI 2.62–3.29) and 3.35 (95% CI 2.94–3.82) for low dose (<6 mg), medium dose (5–12 mg) and high dose (>10 mg) respectively compared with no OCS use. Conclusions: The use of OCS in the management of asthma is associated with a higher risk of complications. This risk is higher as the OCS dose increases.

Keywords:

• Asthma
• oral corticosteroids
• adverse events
• morbidity; burden; economy

Conflict of interest

K.A Fellowship in Severe Asthma was funded in part by AstraZeneca and was also supported in part by an unrestricted educational grant from TEVA. K.M.J and D.W have nothing to disclose. M.S has received funding paid directly to UBC outside the submitted work as well as honorarium from AstraZeneca for acting as a member of advisory board. J.M.F received grants from AstraZeneca paid directly to UBC and also reports personal fees for lecturing and consulting.

Additional information

Funding

This study was funded by an unrestricted research grant from AstraZeneca Canada, which was provided directly to the University of British Columbia. The sponsor did not have any role in the conduct and reporting of this study.

Notes on contributors

Khalid Al Efraij

J. M. F. is the guarantor of the manuscript. J. M. F. is responsible for the concept of the study. K.A and D.W. extracted data from included studies. K.M.J. performed all statistical analyses. K.A. wrote the first draft of the manuscript. All authors critically commented on the manuscript and approved the final version.

Kate M. Johnson

J. M. F. is the guarantor of the manuscript. J. M. F. is responsible for the concept of the study. K.A and D.W. extracted data from included studies. K.M.J. performed all statistical analyses. K.A. wrote the first draft of the manuscript. All authors critically commented on the manuscript and approved the final version.

Darrin Wiebe

J. M. F. is the guarantor of the manuscript. J. M. F. is responsible for the concept of the study. K.A and D.W. extracted data from included studies. K.M.J. performed all statistical analyses. K.A. wrote the first draft of the manuscript. All authors critically commented on the manuscript and approved the final version.

Mohsen Sadatsafavi

J. M. F. is the guarantor of the manuscript. J. M. F. is responsible for the concept of the study. K.A and D.W. extracted data from included studies. K.M.J. performed all statistical analyses. K.A. wrote the first draft of the manuscript. All authors critically commented on the manuscript and approved the final version.

J. Mark FitzGerald

J. M. F. is the guarantor of the manuscript. J. M. F. is responsible for the concept of the study. K.A and D.W. extracted data from included studies. K.M.J. performed all statistical analyses. K.A. wrote the first draft of the manuscript. All authors critically commented on the manuscript and approved the final version.