Higher Steroid Exposure Linked to Systemic Adverse Events in CRSwNP - Summary - MDSpire
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Higher Steroid Exposure Linked to Systemic Adverse Events in CRSwNP
Higher annual oral corticosteroid exposure was associated with greater odds of systemic adverse events, with avascular bone necrosis and pneumonia showing dose-dependent associations with cumulative dose and osteoporosis associated with longer annual exposure duration.
To investigate the association between annual oral corticosteroid exposure and systemic adverse events in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
Approach:
Study Design: A nationwide nested case-control study using data from the Korean Health Insurance Review and Assessment Service database from 2010 to 2023.
Cohort Description: Included 165,361 adult patients diagnosed with CRSwNP who received at least one oral corticosteroid prescription, excluding those with prior immune-mediated inflammatory diseases or prior adverse event diagnoses.
Data Analysis: Matched analysis included 51,647 case patients and 472,369 controls, assessing oral corticosteroid exposure based on annual treatment duration, cumulative prednisolone-equivalent dose, and prescription frequency.
Key Findings:
Patients receiving at least 1.0 g of prednisolone-equivalent oral corticosteroids per year had 23% higher adjusted odds of any systemic adverse event compared to those receiving less than 0.5 g per year.
Adverse-event-specific analyses showed 2.6 times the odds of avascular bone necrosis and 1.5 times the odds of pneumonia in patients receiving at least 1.0 g/year.
Patients receiving oral corticosteroids for more than 90 days per year had higher adjusted odds of avascular bone necrosis, osteoporosis, and pneumonia.
Interpretation:
Limitations:
Observational design and reliance on administrative claims data from a single national health care system may limit generalizability.
Inability to assess CRSwNP severity, asthma severity, exact clinical indications for prescriptions, medication adherence, and over-the-counter steroid use.
Residual confounding may remain despite matching and statistical adjustments.
