LAUSR

Abstract Aims Systemic corticosteroids (SCS) are used to manage asthma exacerbations. Among the broad population of patients with asthma, SCS-related risk of adverse events (AEs), health care resource utilization (HCRU), and costs remain unclear. Materials and methods This retrospective cohort study used the Optum Research Database claims to identify adults with asthma from 1/1/2017 to 6/30/2022. The index date was the earliest SCS claim for SCS users; non-SCS users were randomly selected and adjusted proportionally to SCS users by index year. SCS use was measured during the first 12 months of follow-up. Inverse probability of treatment weighting balanced the two cohorts for selected baseline demographic and clinical characteristics. SCS users were further stratified into low, medium, and high dose sub-cohorts. SCS-related AEs were assessed up to 48 months, while HCRU and costs were assessed during the first 12 months of follow-up. A generalized linear model (GLM) analyzed follow-up costs by SCS exposure. Results The 130,739 patients included 55,363 non-SCS users (42.3%), while 75,376 were SCS users stratified into 60,319 low-, 12,235 medium-, and 2,822 high-dose users. The mean age was 49.6 years; 61.8% were female and 68.9% were non-Hispanic White. SCS users had a significantly greater risk of new-onset acute and chronic SCS-related AEs, increasing incrementally with dose exposure (all p < .001) across numerous physiological systems. Follow-up HCRU and costs also rose incrementally with dose exposure (all p < .001). Compared with non-users, SCS-related costs were 1.43, 1.97, and 3.21 times higher among low-, medium-, and high-dose users, respectively. The adjusted GLM predicted a 9.9% cost increase per 100 mg of prednisone equivalents. Limitations Retrospective administrative claims studies cannot randomize patients and may not capture all patient events. Conclusions Among a broad population of adults with asthma, even low doses of SCS were associated with significantly increased risk of new-onset AEs, HCRU, and costs. PLAIN LANGUAGE SUMMARY Asthma is a respiratory disease characterized by symptoms that can suddenly flare up, resulting in bronchoconstriction that in some cases requires urgent medical attention. Systemic corticosteroids (SCS) have been used for decades to treat these exacerbations. While effective at relieving symptoms, SCS are associated with detrimental effects of their own. Our study examined the adverse events and costs associated with SCS use. We analyzed the health insurance claims of 130,739 adult patients with asthma: 55,363 (42.3%) did not use systemic corticosteroids, while 75,376 (57.7%) patients received SCS during our study. The SCS users were further divided into groups that were exposed to low, medium, and high SCS doses. Inverse Probability of Treatment Weighting (IPTW) was applied to address potential confounding and infer causal treatment effects of SCS use. The study showed that patients who received SCS were at a significantly increased risk of medication-related adverse events, both in terms of acute and chronic clinical complications. These complications affect a range of systems, including diseases associated with the heart, kidneys, eyes, skin, and brain. Patients who received SCS also incurred greater costs and had more hospitalization and emergency room visits in 12 months. Importantly, the risk and costs increased with the medication dose to which a patient was exposed. Health care costs were 1.43, 1.97, and 3.21 times higher among patients who received low, medium, and high doses of SCS, respectively, than non-SCS users. Even low doses of SCS were associated with a significantly increased risk of adverse events and higher costs.