Using oral corticosteroids for more than 90 days per year may be associated with an increased risk of adverse events in adult patients with atopic dermatitis, according to a new case-control study. However, no increased risk was observed with oral corticosteroid use exceeding 30 days per year.
In the nested case-control study, published in JAMA Network Open, investigators used data from South Korea's Health Insurance Review and Assessment Service database between January 1, 2012, and October 31, 2021 to examine the outcomes of oral corticosteroid use among 164,809 patients with atopic dermatitis who experienced an adverse event—including osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataract, or glaucoma—and 328,303 controls matched on the basis of sex, age, cohort entry date, follow-up duration, and atopic dermatitis severity.
Among the study population, 3.4% (n = 5,533) of the patients with atopic dermatitis and 3.2% (n = 10,561) of controls were exposed to oral corticosteroids for more than 30 days, while 0.4% (n = 684) of those with atopic dermatitis and 0.4% (n = 1,153) of controls were exposed for more than 90 days. Use of oral corticosteroids exceeding 90 days was associated with an 11% increased risk of the composite adverse outcome (adjusted odds ratio [OR] = 1.11, 95% confidence interval [CI] = 1.01–1.23), with each additional cumulative or consecutive year of long-term exposure linked to a 6% increased risk (adjusted OR = 1.06, 95% CI = 1.00–1.13 for both). No increased risk was found among the patients who used oral corticosteroids for over 30 days (adjusted OR = 1.00, 95% CI = 0.97–1.04).
In analyses of individual adverse events, oral corticosteroid use exceeding 30 days was associated with an increased risk of hypertension (adjusted OR = 1.09, 95% CI = 1.03–1.15), avascular necrosis (adjusted OR = 2.56, 95% CI = 1.82–3.62), and cataracts (adjusted OR = 3.22, 95% CI = 1.05–9.85). Use exceeding 90 days was linked to a higher risk of fractures (adjusted OR = 1.22, 95% CI = 1.05–1.42), hyperlipidemia (adjusted OR = 1.16, 95% CI = 1.03–1.30), myocardial infarctions (adjusted OR = 2.22, 95% CI = 1.17–4.22), and avascular necrosis (adjusted OR = 6.88, 95% CI = 3.53–13.42).
The findings were generally consistent across subgroup analyses stratified by age, sex, and atopic dermatitis severity. Sensitivity analyses also demonstrated the robustness of the results.
The investigators noted that limitations of the study included potential misclassification of diagnoses, lack of clinical data such as diagnostic criteria for atopic dermatitis, and inability to account for inhaled, topical, and ophthalmic corticosteroid use. Nonetheless, they emphasized the study's large sample size and comprehensive examination of adverse events specifically in adults with atopic dermatitis.
"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 [atopic dermatitis], 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]," the study authors concluded.