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A nested case-control study found that limiting the treatment duration of oral corticosteroids in patients with exacerbations of atopic dermatitis (AD) to 90 days or fewer may limit the impact of adverse effects (AEs).1 The study, published by JAMA Network Open, noted that in general, international guidelines and experts in the field recommend avoiding oral corticosteroids or limiting their use to short-term administration as a rescue therapy.
“Nonetheless, given the benefits of oral corticosteroids, including their effectiveness in allergic diseases, short-term safety, and low cost, many patients with moderate to severe AD are treated with oral corticosteroids for prolonged periods, which may constitute inappropriate or excessive use,” the study authors wrote. “However, oral corticosteroid treatment for prolonged periods could have an association with oral corticosteroid–related complications. Hence, clinical evidence informing patients and practitioners regarding the management of AD exacerbations in routine clinical practice is warranted. Although previous studies among patients with asthma or rheumatic disease have suggested associations between long-term use of oral corticosteroids and various (AEs), there are few studies of patients with AD, to our knowledge.”1
Patients with AD, a chronic inflammatory skin condition, may experience skin dryness, erythema, oozing, crusting, and thick and leathery skin. The strongest risk factor for AD is familial history, as history of AD in one parent can elevate their offspring’s risk of AD by 1.5-fold. This risk increases to 3- to 5-fold if both parents have AD. Treatment of AD typically involves limiting the symptoms with disease control and preventing exacerbations, while patients with moderate to severe AD are administered systemic therapies.2
Patients with AD may experience a wide range of comorbidities, as well as pruritus and quality of life issues. Although it is primarily a pediatric disease, between 2.1% and 4.9% of international adults have AD, with up to 10% showing inadequate response to topical therapies, requiring medication to manage their moderate to severe AD.1
These rates are higher among adults than in pediatric patients, with only 1.5% needing medication for moderate to severe AD. To evaluate the impact that long-term use of oral corticosteroids has on AEs in adults with AD, investigators conducted the study with data from the Health Insurance Review and Assessment Service database of South Korea between January 1, 2012, and October 31, 2021.
Among the trial’s patient population, those diagnosed with one of 11 AEs were matched with patients who had not reported any of the 11 AEs. These AEs are osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataract, and glaucoma. Investigators defined long-term oral corticosteroid use as cumulative supply of more than 30 days or more than 90 days of oral corticosteroid prescription per year.
The analysis included 1,025,270 patients with AD between 2013 and 2020, with investigators matching 164,809 cases (mean [SD] age, 39.4 [14.8]; 56.9% women) with 328,303 controls (mean [SD] age, 39.3 [14.7]; 56.9% women) for sex, age, cohort entry date, follow-up duration, and severity of AD.
Of these patients, researchers identified 5533 cases and 10,561 controls who used oral corticosteroids for more than 30 days, with 684 cases and 1153 controls with more than 90 days of exposure. Investigators did not find an elevated risk of AEs with oral corticosteroid use lasting more than 30 days (adjusted odds ratio [AOR], 1.00; 95% CI, 0.97-1.04). This risk was slightly higher in patients who used oral corticosteroids for more than 90 days (AOR, 1.11; 95% CI, 1.01-1.23). This small increase in AE risk was found with each cumulative or consecutive year of long-term use.
“In this large population-based case-control study, we discovered that oral corticosteroid use of more than 90 days among individuals with AD was associated with a small increased risk of composite adverse outcomes,” the study authors concluded. “Future investigations are warranted to confirm this potential risk of AEs associated with long-term use of oral corticosteroids for patients with exacerbations of AD, and health care professionals should thoroughly weigh the benefits associated with oral corticosteroids against the observed small risk of AEs, while continuously monitoring for AEs.”
References
1. Jang YH, Choi E, Lee H, et al. Long-Term Use of Oral Corticosteroids and Safety Outcomes for Patients With Atopic Dermatitis. JAMA Netw Open. 2024;7(7):e2423563. doi:10.1001/jamanetworkopen.2024.23563. Published July 19, 2024.
2. Brown SJ, Elias MS, Bradley M. Genetics in Atopic Dermatitis: Historical Perspective and Future Prospects. Acta Derm Venereol. 2020;100(12):adv00163. Published June 9, 2020.