title: Burden of systemic glucocorticoid-related complications in severe asthma.
abstract: Although systemic glucocorticoids (SGCs) are efficacious, their chronic use is associated with a range of complications. Yet limited data are available about the risks following chronic use in patients with severe asthma, who are at risk of long-term SGC-related complications. This study was carried out to investigate the risks of developing SGC-related complications, and to quantify the associated healthcare resource utilization and costs for patients with severe asthma in the United States.
  
  
  
  This was a longitudinal, open-cohort, observational study. Medicaid claims data (1997-2013) for patients ≥12 years old with ≥2 asthma diagnoses were used. A total of 26,987 SGC non-users were identified for inclusion in the study, alongside 3628 SGC users with ≥6 months' continuous SGC use.
  
  
  
  Multivariate generalized estimating equation models were used to estimate the adjusted risk of developing SGC-related complications, and to quantify the associated healthcare resource utilization and costs. This analysis compared SGC users with SGC non-users, and found that SGC users had an increased likelihood of developing complications. A significant dose-response relationship was demonstrated between chronic SGC use and risk of developing any complications (odds ratios for low, medium, and high SGC exposure were 2.03 [p = .0511], 2.85 [p < .0001], and 3.64 [p < .0001], respectively, vs. SGC non-users). The increased likelihood of SGC-related complications translated into estimated annual healthcare costs for SGC users of $2712 to $8560 above those of SGC non-users. A key limitation of this study is the disparity in age between the SGC users and the SGC non-users; however, age was included as a confounding factor in the analysis.
  
  
  
  These findings confirm the risk associated with chronic use of SGCs, irrespective of dose level, and highlight the need for new SGC-sparing treatment strategies for patients with severe asthma.
authors.affiliation: a Groupe d'analyse , Ltée Montréal , Québec , Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.affiliation: b Analysis Group Inc. , Boston , MA , USA.
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
authors.affiliation: a Groupe d'analyse , Ltée Montréal , Québec , Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Lafeuille
authors.affiliation: a Groupe d'analyse , Ltée Montréal , Québec , Canada.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gozalo
authors.affiliation: b Analysis Group Inc. , Boston , MA , USA.
authors.forename: Urvi
authors.initials: U
authors.lastname: Desai
authors.affiliation: a Groupe d'analyse , Ltée Montréal , Québec , Canada.
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Robitaille
authors.affiliation: c GlaxoSmithKline , Durham , NC , USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Albers
authors.affiliation: c GlaxoSmithKline , Durham , NC , USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Yancey
authors.affiliation: c GlaxoSmithKline , Durham , NC , USA.
authors.forename: Hector
authors.initials: H
authors.lastname: Ortega
authors.affiliation: c GlaxoSmithKline , Durham , NC , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Forshag
authors.affiliation: c GlaxoSmithKline , Durham , NC , USA.
authors.forename: Xiwu
authors.initials: X
authors.lastname: Lin
authors.affiliation: c GlaxoSmithKline , Durham , NC , USA.
authors.forename: Anand A
authors.initials: AA
authors.lastname: Dalal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D017281:Cost of Illness; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
chemical_list: D005938:Glucocorticoids
keywords: Economic burden; healthcare cost; severe asthma; systemic glucocorticoids