Patients with exacerbations of atopic dermatitis (AD) who take oral corticosteroids to treat their condition for over 90 days may be at an increased risk of experiencing adverse events, according to new research published in JAMA Network Open.1 The authors said the study findings support the continual monitoring for adverse events when patients are taking oral corticosteroids.
In the United States, 7% to 11% of adults are impacted by AD, otherwise known as eczema. The condition has a high disease burden due to time spent managing symptoms, which include its visible nature and itch.2 Oral corticosteroids provide some benefits, but few studies have looked into possible adverse events associated with long-term use in patients with AD.
Key Takeaways
- Patients with atopic dermatitis (AD) who use oral corticosteroids for more than 90 days may experience an increased risk of adverse events such as fractures, hyperlipidemia, myocardial infarction, and avascular necrosis.
- Despite international guidelines recommending short-term use of oral corticosteroids for AD, many patients with moderate to severe AD are treated with these drugs for prolonged periods.
- The study calls for future investigations to confirm the potential risks associated with long-term oral corticosteroid use in AD patients.
“As AD treatment strategies, international guidelines and expert opinions generally recommend that oral corticosteroids should generally be avoided or limited to the short term only as rescue therapy,” the authors wrote. “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.”
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Investigators from Kyungpook National University and Sungkyunkwan University conducted a study to assess the association between long-term exposure to oral corticosteroids and adverse events among adult patients with AD. Data for the nested case-control study was gathered from the Health Insurance Review and Assessment Service database of South Korea between January 2012 and October 2021.
The study cohort included 164809 patients with at least 1 prescription of oral corticosteroids between 2013 and 2020 who were matched with 328303 controls. Of the patients who had at least 1 prescription, the mean age was 39.4, 56.9% were women and 43.1% were men. Patients were excluded if they had a diagnosis of immune-mediated inflammatory diseases during a 1-year window of exclusion assessment before the cohort entry date, had a diagnosis of any of 11 outcomes of interest, or were younger than 18 years of age.
During the study period, 5533 patients and 10561 controls were exposed to oral corticosteroids for more than 30 days, while 684 patients and 1153 controls were exposed for more than 90 days. Investigators found that there was no increased risk of adverse events with use of oral corticosteroids for more than 30 days. However, the risk was slightly higher for those who used them for more than 90 days.
The most common adverse events in those using oral corticosteroids for more than 90 days included fracture, hyperlipidemia, myocardial infarction, and avascular necrosis.
Study limitations include disparities between the diagnoses recorded and the actual diseases a patient had, a potentially uncertain exposure measurement, that inhaled corticosteroids, topical, and eye drop formulations were not accounted for, and the nature of the case-control study design, which made it not possible to completely exclude reverse causality.
“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 authors concluded. “Future investigations are warranted to confirm this potential risk of adverse events 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 adverse events, while continuously monitoring for adverse events.”
READ MORE: Dermatology Resource Center
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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
2. Elsawi R, Dainty K, Smith Begolka W, et al. The Multidimensional Burden of Atopic Dermatitis Among Adults: Results From a Large National Survey. JAMA Dermatol. 2022;158(8):887–892. doi:10.1001/jamadermatol.2022.1906
