Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.
Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.
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DOI：
10.1136/bmj.j1415
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发表时间：
2017-04-12
期刊：
影响因子：
--
通讯作者：
Nallamothu BK
中科院分区：
文献类型：
--
作者：
Waljee AK;Rogers MA;Lin P;Singal AG;Stein JD;Marks RM;Ayanian JZ;Nallamothu BK
目的确定短期使用口服皮质类固醇的处方频率，以及与其使用相关的不良事件（脓毒症、静脉血栓栓塞、骨折）。设计回顾性队列研究和自身对照病例系列。设置全国范围内的私人保险索赔数据集。对象2012年至2014年连续入组的18至64岁成人。主要结果测量口服皮质类固醇短期使用率，定义为持续时间少于30天。皮质类固醇使用者和非使用者中不良事件的发生率。开始给药后30天和31-90天风险期内不良事件的发生率比。结果在1548945名成人中，327452人（21.1%）在3年内至少接受过一次短期口服糖皮质激素的门诊处方。老年患者、女性和白色成年人使用更频繁，具有显著的区域差异（均P<0.001）。最常见的适应症是上呼吸道感染、脊柱疾病和过敏。处方是由各种各样的专业提供的。在开始给药后30天内，败血症（发生率比5.30，95%置信区间3.80 - 7.41）、静脉血栓栓塞（3.33，2.78 - 3.99）和骨折（1.87，1.69 - 2.07）的发生率增加，随后31-90天内减少。泼尼松等效剂量低于20 mg/d时，风险增加持续存在（脓毒症发生率比为4.02，静脉血栓栓塞发生率比为3.61，骨折发生率比为1.83;均P<0.001）。结论：在商业保险计划中，五分之一的美国成年人在三年内短期使用口服皮质类固醇处方，不良事件的风险增加。
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.
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DOI：
10.1001/jama.2015.4468
发表时间：
2015-05-19
期刊：
JAMA
影响因子：
--
作者：
Goldberg H;Firtch W;Tyburski M;Pressman A;Ackerson L;Hamilton L;Smith W;Carver R;Maratukulam A;Won LA;Carragee E;Avins AL
通讯作者：
Avins AL
影响因子：
5.8
作者：
Kauh, Eunkyung;Mixson, Lori;Ruddy, Marcella
通讯作者：
Ruddy, Marcella
影响因子：
158.5
作者：
LITTENBERG, B;GLUCK, EH
通讯作者：
GLUCK, EH
影响因子：
27.4
作者：
Gudbjornsson, B;Juliusson, UI;Gudjonsson, FV
通讯作者：
Gudjonsson, FV
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN