title: Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study.
abstract: BACKGROUND
  Tendinotoxicity of glucocorticoids (GC) has been shown, but evidence on how this translates into clinical practice remains scarce.
  
  
  OBJECTIVE
  To explore the association between oral or inhaled GC use and the risk of Achilles or biceps tendon rupture (ATR/BTR).
  
  
  METHODS
  We identified patients aged 18 to 89 years with incident ATR or BTR (1995-2013) for a matched (1:4) case-control analysis using the UK-based Clinical Practice Research Datalink. We stratified oral GC use by indication, timing and duration of use, continuous versus intermittent use, cumulative dose, and average daily dose. We stratified inhaled GC use by timing and number of prescriptions.
  
  
  RESULTS
  Among 8,202 cases, we observed increased odds ratios (ORs) around 3.0 for continuous oral GC use, which declined shortly after therapy cessation (similarly across indications). Odds ratios increased with average daily dose (≥ 10 mg/day, OR 4.05, 95% CI 2.32-7.08) and were elevated after one cycle of high-dose oral GC (≥ 20 mg/day). There was no effect of inhaled GC at any level of exposure.
  
  
  CONCLUSIONS
  Our results provide evidence that oral GC therapy increases the risk of tendon rupture in a dose-response relationship. A single short-term high-dose GC treatment course may be sufficient transiently to increase the risk of tendon rupture.
authors.affiliation: a Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences , University of Basel , Switzerland.|b Hospital Pharmacy, University Hospital Basel , Basel , Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Spoendlin
authors.affiliation: c Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel , Basel , Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Meier
authors.affiliation: d Boston Collaborative Drug Surveillance Program, Boston University School of Public Health , Lexington , MA , USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
authors.affiliation: a Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences , University of Basel , Switzerland.|b Hospital Pharmacy, University Hospital Basel , Basel , Switzerland.|d Boston Collaborative Drug Surveillance Program, Boston University School of Public Health , Lexington , MA , USA.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Meier
mesh_terms: D000125:Achilles Tendon / Q000187:drug effects* / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000069451:Long Term Adverse Effects / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012421:Rupture / Q000139:chemically induced; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: Adverse event; Clinical Practice Research Datalink; glucocorticoids; observational; tendon rupture