Morbidities Associated with Chronic Oral Glucocorticoid Exposure in Children with Asthma: A Real-World Analysis of Medical and Pharmacy Claims
Monday, March 5, 2018
South Hall A2 (Convention Center)
David P. Skoner, MD, Evgeniya N. Antonova, PhD, MS, Amanda M. Kong, MPH, Gregory Lenhart, Ahmar Iqbal, MD, W. Gerald Teague, MD
RATIONALE: Although a mainstay of asthma therapy, oral glucocorticoids (OG) may increase risk of morbidities in children. We aimed to assess the possible adverse events (PAE) of chronic OG (C-OG) exposure in a large claims dataset of children with asthma.

METHODS: We identified continuously-enrolled privately-insured children (6-17 y.o.) with asthma (ICD-9-CM: 493.xx) who did or did not initiate C-OG (>=15-day continuous use) during 2009-2014. We excluded subjects with C-OG or chronic PAE 12 months before initiating C-OG. We used Cox proportional hazard model to estimate PAE relative risk, adjusted for: cumulative-dose ICS, other prescription glucocorticoids (topical, inhaled, IV), number of ICD-9 diagnoses, number of national drug codes, demographics, and treatment year.

RESULTS: Among 2,376 C-OG initiators (mean age: 10.5 years; 62.0% male), the mean cumulative prednisone-equivalent exposure (PEqE) totaled 1,125.5 mg/year; 21.8% used high-dose ICS. Among 7,584 children without C-OG (mean age: 10.5 years; 61.6% male), mean PEqE comprised 178.6 mg/year (OCS bursts); 12.2% used high-dose ICS.

The following PAE’s were associated with C-OG exposure (adjusted relative risk): adrenal insufficiency, 12.13 (p=0.0001), recurrent pneumonia, 1.97 (p<0.0001), gastrointestinal disorders, 1.68 (p<0.0001), persistent cough, 1.67 (p<0.0001), behavioral problems, 1.37 (p=0.0002), sleep disorders, 1.45 (p=0.0156), sinusitis, 1.17 (p=0.0068).

Other PAE were studied, but did not demonstrate statistical significance: bone related events (fracture, osteoporosis, osteopenia), fracture, hypertension, short stature, obesity, oropharyngitis.

CONCLUSIONS: Children with asthma treated with chronic oral glucocorticoids experience significant morbidities, including adrenal suppression, recurrent pneumonia, and behavioral problems. In appropriate patients with uncontrolled asthma, clinicians should consider effective alternative treatments to avoid these potential complications.