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Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.

Abstract Objective To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use.Design Retrospective cohort study and self controlled case series.Setting Nationwide dataset of private insurance claims.Participants Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014.Main outcome measures Rates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation.Results Of 1 548 945 adults, 327 452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001).Conclusion One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events.
PMID
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Authors

Mayor MeshTerms

Adrenal Cortex Hormones

Drug-Related Side Effects and Adverse Reactions

Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28404617
OWN - NLM
STAT- MEDLINE
DA  - 20170413
DCOM- 20170417
LR  - 20170417
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 357
DP  - 2017 Apr 12
TI  - Short term use of oral corticosteroids and related harms among adults in the
      United States: population based cohort study.
PG  - j1415
LID - 10.1136/bmj.j1415 [doi]
AB  - Objective To determine the frequency of prescriptions for short term use of oral 
      corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures)
      associated with their use.Design Retrospective cohort study and self controlled
      case series.Setting Nationwide dataset of private insurance claims.Participants
      Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014.Main 
      outcome measures Rates of short term use of oral corticosteroids defined as less 
      than 30 days duration. Incidence rates of adverse events in corticosteroid users 
      and non-users. Incidence rate ratios for adverse events within 30 day and 31-90
      day risk periods after drug initiation.Results Of 1 548 945 adults, 327 452
      (21.1%) received at least one outpatient prescription for short term use of oral 
      corticosteroids over the three year period. Use was more frequent among older
      patients, women, and white adults, with significant regional variation (all
      P&lt;0.001). The most common indications for use were upper respiratory tract
      infections, spinal conditions, and allergies. Prescriptions were provided by a
      diverse range of specialties. Within 30 days of drug initiation, there was an
      increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval
      3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87,
      1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased
      risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence
      rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for
      fracture; all P&lt;0.001).Conclusion One in five American adults in a commercially
      insured plan were given prescriptions for short term use of oral corticosteroids 
      during a three year period, with an associated increased risk of adverse events.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Waljee, Akbar K
AU  - Waljee AK
AD  - VA Center for Clinical Management Research, Ann Arbor, MI, USA
      [email protected]
AD  - University of Michigan Medical School, Institute for Healthcare Policy and
      Innovation, Ann Arbor, MI, USA.
AD  - University of Michigan Medical School, Department of Internal Medicine, Division 
      of Gastroenterology and Hepatology, Ann Arbor, MI, USA.
AD  - Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP),
      Ann Arbor, MI, USA.
FAU - Rogers, Mary A M
AU  - Rogers MA
AD  - University of Michigan Medical School, Institute for Healthcare Policy and
      Innovation, Ann Arbor, MI, USA.
AD  - Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP),
      Ann Arbor, MI, USA.
AD  - University of Michigan Medical School, Department of Internal Medicine, Division 
      of General Medicine, Ann Arbor, MI, USA.
FAU - Lin, Paul
AU  - Lin P
AD  - University of Michigan Medical School, Institute for Healthcare Policy and
      Innovation, Ann Arbor, MI, USA.
FAU - Singal, Amit G
AU  - Singal AG
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center,
      Dallas, TX, USA.
FAU - Stein, Joshua D
AU  - Stein JD
AD  - University of Michigan Medical School, Institute for Healthcare Policy and
      Innovation, Ann Arbor, MI, USA.
AD  - University of Michigan Medical School, Department of Ophthalmology and Visual
      Science, Ann Arbor, MI, USA.
AD  - University of Michigan School of Public Health, Department of Health Management
      and Policy, University of Michigan, Ann Arbor, MI, USA.
FAU - Marks, Rory M
AU  - Marks RM
AD  - University of Michigan Medical School, Department of Internal Medicine, Division 
      of Rheumatology, Ann Arbor, MI, USA.
FAU - Ayanian, John Z
AU  - Ayanian JZ
AD  - University of Michigan Medical School, Institute for Healthcare Policy and
      Innovation, Ann Arbor, MI, USA.
AD  - University of Michigan Medical School, Department of Internal Medicine, Division 
      of General Medicine, Ann Arbor, MI, USA.
AD  - University of Michigan School of Public Health, Department of Health Management
      and Policy, University of Michigan, Ann Arbor, MI, USA.
FAU - Nallamothu, Brahmajee K
AU  - Nallamothu BK
AD  - VA Center for Clinical Management Research, Ann Arbor, MI, USA.
AD  - University of Michigan Medical School, Institute for Healthcare Policy and
      Innovation, Ann Arbor, MI, USA.
AD  - Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP),
      Ann Arbor, MI, USA.
AD  - University of Michigan Medical School, Department of Internal Medicine, Division 
      of Cardiovascular Medicine, Ann Arbor, MI, USA.
LA  - eng
PT  - Journal Article
DEP - 20170412
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Adrenal Cortex Hormones)
SB  - AIM
SB  - IM
MH  - Administration, Oral
MH  - *Adrenal Cortex Hormones/administration &amp; dosage/adverse effects
MH  - Adult
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - *Drug-Related Side Effects and Adverse
      Reactions/classification/epidemiology/etiology
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'/statistics &amp; numerical data
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Time Factors
MH  - United States/epidemiology
EDAT- 2017/04/14 06:00
MHDA- 2017/04/18 06:00
CRDT- 2017/04/14 06:00
PST - epublish
SO  - BMJ. 2017 Apr 12;357:j1415. doi: 10.1136/bmj.j1415.

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