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Corticosteroids: Drug Facts, Side Effects and Dosing
Administration of oral corticosteroids is associated with the development of osteoporosis and an increased risk of fractures. The objective of this study was to investigate the usage pattern of oral corticosteroids in a large sample representative of the general population in England and Wales.
Oral corticosteroid users were patients aged 18 years or older who received one or more prescriptions for oral corticosteroids. At any point in time, oral corticosteroids were being used by 0. The highest use 2. Administration of oral corticosteroids has been associated with the development of osteoporosis and an increased risk of fracture.
The objective of this study was to investigate the usage patterns of oral corticosteroids in a large sample representative of the general population in England and Wales; information was obtained from the General Practice Research Database GPRD which contains the computerized medical records of a large group of medical practices in England and Wales.
There was particular interest in estimating the prevalence of oral corticosteroid usage, as well as the dose and natural history of utilization. The data recorded in the GPRD include demographic information, prescription details, clinical events, preventive care provided, specialist referrals, hospital admissions and their major outcomes.
Several independent validation studies have confirmed a high level of completeness and validity of GPRD, 22— 25 which is owned by the Department of Health in the UK. The study sample was selected from the GPRD to comprise a large retrospective cohort study aiming to evaluate the relationship between oral corticosteroid use and fracture risk. The average for this time period was 4. For each oral corticosteroid user, the daily corticosteroid dose over the total treatment period was estimated by dividing the total amount of prescribed prednisolone or equivalent dose in milligrams by the treatment time.
Three dose categories were assigned: The indication for oral corticosteroid treatment was obtained by reviewing the morbidity recorded at the date on which a new course of treatment was started. At the commencement of new drug treatment, the general practitioners are required to record the indication for treatment on the same date in the medical record. Patients who received their first oral corticosteroid prescription at least 6 months after they were registered at the practice or after the practice enrolled in GPRD were considered to have started a new course of treatment.
The morbidity recorded at the date of starting the oral corticosteroids was categorized according to the International Classification of Diseases 9th revision categories. Patients were also classified according to the presence of concomitant disease.
This classification was based on the clinical details recorded during the period from 6 months before commencing treatment until the cessation of oral corticosteroid treatment. A point prevalence estimate for oral corticosteroid use in the total adult GPRD population was estimated by dividing the total duration of oral corticosteroid use by the total observation time of GPRD.
The total duration of oral corticosteroid use for this analysis was based on the length of use with each individual prescription.
Patients were considered to have discontinued treatment if they did not receive a repeat prescription within 3 months after the last oral corticosteroid prescription.
Patients who transferred out, who died within 3 months of their last prescription, or who received their last prescription in the last 3 months of the study were censored. The mean and median numbers of prescriptions were 6.
Prednisolone was the most frequently prescribed oral corticosteroid Hydrocortisone and dexamethasone were given in 3. The use of oral corticosteroids varied substantively over age, but was similar between males and females. The highest use was by patients between 70 and 79 years of age 2.
Of the three dose categories, the intermediate dose 2. For all three dose categories, patients aged 70—79 years were using oral corticosteroids most frequently 0. The lowest use was found in patients aged 20 to 29 years 0. The most frequently recorded indication for oral corticosteroid treatment was respiratory disease: Most patients received corticosteroid treatment for a short period of time. The utilization pattern was similar for both sexes, but elderly patients used oral corticosteroids for longer periods than younger patients.
Oral corticosteroid treatment was continued for over 2 years by In a separate analysis, we examined the impact of dose on the continuation of oral corticosteroid treatment. Patients on higher doses of oral corticosteroids were more likely to continue treatment for longer periods of time: Patients with arthropathies were most likely to continue treatment: Patients with chronic obstructive pulmonary disease were least likely to continue treatment 6.
The use of bisphosphonates increased among users of high doses of oral corticosteroids from 0. At 5 years, the highest use of bisphosphonates was observed among the women aged 45—84 years using high doses of oral corticosteroids 6.
Similarly, the use of vitamin D increased from 0. The women aged 45 to 84 years showed the highest use 2. Concomitant use of calcitonin was very low in all three dose groups. The use of HRT did not change substantially over duration of oral corticosteroid treatment. HRT use was the highest among the women aged 45—64 years.
Of the women aged 45—54 years, For the women aged 55—64 years, this figure was Percentage of patients who continued oral corticosteroid treatment over time, stratified by concomitant disease.
We have evaluated the utilization patterns of oral corticosteroids in a large cohort representative of the general population of England and Wales. Oral corticosteroids are used frequently, especially by the elderly. High doses of oral corticosteroids, which have the largest associated fracture risk, were used by 0.
Most information on the adverse bone effects of oral corticosteroids has been obtained from studies that evaluated changes in bone density during oral corticosteroid treatment.
Of the adult GPRD population, 0. Extrapolation of these figures to the UK population as a whole approximately Fracture rates appear to increase even for those using lower doses of oral corticosteroids at doses between 2.
Three small studies have evaluated fractures rates in subgroups of oral corticosteroid users. These studies only evaluated age and gender and had inconsistent results, possibly due to the small numbers of patients. They were used for a broad range of indications, at different doses, for varying durations and by patients of different age, gender and medical histories. The use of oral corticosteroids in the UK has been addressed in two previous studies.
Our study used a large longitudinal cohort with accrual of the study population over several years of observation. When weighting patients according to duration of use, respiratory disease accounted for The greater frequency of pulmonary disease in our study is most likely to be explained by this difference in study design.
Furthermore, our study was conducted in a large group of general practices which have registered a patient population that is known to be broadly representative of the population of England and Wales. The physicians of GPRD are expected to record the indication on the date of starting the treatment.
For repeat prescriptions, it is normally only necessary to enter the indication the first time the drug is being used. One possible explanation may be that oral corticosteroids may have already been previously prescribed, prior to the start of data collection for GPRD. In conclusion, we have shown that oral corticosteroids are widely used over a broad range of indications for varying durations of time.
Further studies to characterize the risk factors for fracture in corticosteroid users, and measures to identify and treat those subjects at the highest risk of future fracture, are urgently required. The manuscript was prepared by Mrs G. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation.
Use of oral corticosteroids in the United Kingdom T. Address correspondence to Professor C. Abstract Administration of oral corticosteroids is associated with the development of osteoporosis and an increased risk of fractures.
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