1. Brahmajee K. Nallamothu, MD, MPH
Short-Term Use of Oral Corticosteroids and Related Harms Among Adults in the United States
Akbar K. Waljee, MD, MS
Mary A. M. Rogers, PhD, MS
Paul Lin, MS
Amit G. Singal, MD
Joshua D. Stein, MD, MS
Rory M. Marks, MB, BS
John Z. Ayanian, MD, MPP
Brahmajee K. Nallamothu, MD, MPH

2. Corticosteroids are powerful anti-inflammatory drugs.
They have been used for decades.
Long-term use has been associated with adverse effects but there are fewer studies regarding low-dose short-term use.

3. The purpose of this study was
to characterize contemporary outpatient utilization of short-term oral corticosteroids
and
to examine the risk of acute adverse events.

4. Clinformatics Data Mart
14+ years of data for over 61 million unique members, all with both medical and pharmacy benefits.
Between 12.4 and 14 million unique members each year.

5. We identified all individuals, ages 18 to 64 years, who were continuously enrolled between January 1, 2012 and December 31, 2014.
Our primary exposure of interest was an outpatient prescription for an oral formulation of corticosteroids for less than 30 days in duration.

6. Pharmacy files

7. Medical files

8. We answered several questions:
How often are low-dose short term corticosteroids used?
Among 1,548,945 adults in the study, 21.1% received at least one outpatient prescription in the 3-year period.

9. What were the characteristics
of the users?

11. What was the indication for treatment?
Who prescribed the corticosteroids?
Diagnosis codes were grouped using Clinical Classification Software obtained from the Agency for Healthcare Research and Quality.

12. Are there adverse events associated with use?
Hospitalization for sepsis
Venous thromboembolism
Fracture

13. How to assess adverse events? Compare users to nonusers.

15. Adverse Events within 5 to 90 days
after a Clinic Visit
Corticosteroid Users
Nonusers
Hospitalization for sepsis
0.05%
0.02%
Venous thromboembolism
0.14%
0.09%
Fracture
0.51%
0.39%

16. How to assess adverse events? Compare a person to him/herself.

17. How to assess adverse events? Compare a person to him/herself.
Self controlled case series.

18. Incidence Rate Ratios

19. Incidence Rate Ratios

20. CONCLUSIONS
Over a 3-year period, approximately 1 in 5 American adults in a commercially-insured plan used oral corticosteroids for a duration of less than 30 days.
The short-term use of these drugs was associated with increased rates of sepsis, venous thromboembolism, and fracture – even at relatively low doses.

21. Thank you.