Safest Duration for Oral Corticosteroid Use in Adults With Atopic Dermatitis?
– Study finds no increased AE risk after 30 days, slight increase after 90 days
Limiting oral corticosteroid treatment to 90 days or less may limit adverse effects (AEs) in people with atopic dermatitis (AD).
This and other findings from a nested case-control study appear in .
A total of 5,533 patients (3.4%) with AD exacerbation and 10,561 controls (3.2%) were exposed to oral corticosteroids for more than 30 days, while 684 cases (0.4%) and 1,153 controls (0.4%) were exposed for more than 90 days.
Overall, there was no increased risk of AEs with use of oral corticosteroids for more than 30 days (AOR 1.00; 95% CI 0.97-1.04) compared with control. There was a slightly higher risk of AEs associated with the use of oral corticosteroids for more than 90 days (AOR 1.11; 95% CI 1.01-1.23).
The study was conducted by researchers based in South Korea. The following paper excerpts were edited for length and clarity.
Why the need for this investigation?
Although previous studies among patients with asthma or rheumatic disease have suggested associations between long-term use of oral corticosteroids and various AEs, there have been few studies in patients with AD, researchers wrote.
Considering the frequent use of oral corticosteroids among adults with AD and the potential association between long-term use and AEs -- some of which can be severe -- researchers sought to investigate the safety of long-term use in South Korean adults with AD.
What was the key finding?
The risk of composite adverse outcomes was not associated with ever long-term use of oral corticosteroids exceeding 30 days, whereas the AE risk was slightly higher with ever long-term use that exceeded 90 days in duration.
What specific AEs were most common?
After 30 days of oral corticosteroid use, small increased risks appeared for hypertension (AOR 1.09; 95% CI 1.03-1.15), avascular necrosis (AOR 2.56; 95% CI 1.82-3.62), and cataract (AOR 3.22; 95% CI 1.05-9.85).
After 90 days, oral corticosteroid use was associated with increased risks for fracture (AOR 1.22; 95% CI 1.05-1.42), hyperlipidemia (AOR 1.16; 95% CI 1.03-1.30), myocardial infarction (AOR 2.22; 95% CI 1.17-4.22), and avascular necrosis (AOR 6.88; 95% CI 3.53-13.42).
What are the key take-home messages for dermatologists?
No increased risk or association emerged between corticosteroid use and osteoporosis, glaucoma, stroke, or heart failure. This implies that the dose and duration of corticosteroid treatment may not pose a risk for these conditions among patients with AD.
The study was supported by Pfizer Pharmaceuticals Korea. Study co-authors Ja-Young Jeon and Eun-Young Yoo reported receiving personal fees from Pfizer Pharmaceuticals Korea Ltd outside the submitted work. Study co-author Ju-Young Shin reported receiving financial support from Celltrion and SK Bioscience outside the submitted work. No other disclosures were reported of relevant financial relationships with industry.
Primary Source
JAMA Network Open
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