In a study of nearly 2 million patients in the United Kingdom, researchers found that corticosteroid prescribing in primary care was highly concentrated. Just 20% of oral and inhaled corticosteroid users accounted for nearly 80% of all prescriptions.
Researchers analyzed electronic health records from over 1,400 general practices in England between 2000 and 2021. It focused on new users of oral, injectable, and inhaled corticosteroids, using a national database that covers approximately one-quarter of the UK population.
Among the 1.9 million patients included, more than 1.3 million were prescribed oral corticosteroids, over 900,000 inhaled corticosteroids, and 140,000 injectable corticosteroids. Prednisolone was the most frequently prescribed oral steroid, and beclometasone was the most common inhaled formulation.
The investigators evaluated treatment duration and coverage over time. For oral corticosteroids, 20% of patients remained on treatment after 2 months. For inhaled corticosteroids, 50% remained on treatment at the same point.
Treatment coverage was also measured using the Proportion of Patients Covered (PPC) method. Six months after treatment initiation, 30% of oral corticosteroid users and 60% of inhaled corticosteroid users remained covered by therapy.
“Almost 80% of oral [coricosteriod] uers received continuous treatment during the first month of their follow-up, with a sharp drop to 20% (Hazard Ratio, HR: 0.205; 95% Confidence Interval, CI: 0.200–0.206) after 2 months,” reported Eleni Domzaridou, PhD, from the Nuffield Department of Population Health, University of Oxford, and colleagues.
Older patients and those with chronic conditions—such as inflammatory bowel disease, rheumatoid arthritis, or chronic lung diseases—were more likely to remain on corticosteroids and to receive higher doses. High daily doses of oral corticosteroids (>7.5 mg) were more common among women over 35 and men over 45. Most inhaled corticosteroid users received low daily doses (<500 μg).
Injectable corticosteroids were prescribed less frequently. More than half of injectable corticosteroids users received only one prescription, and fewer than 7% received five or more during follow-up.
There was also variation in prescribing based on region and socioeconomic status. Most corticosteroid users were from more deprived areas, and regional differences in prescribing patterns were noted across England.
The investigators noted that identifying patients with high corticosteroid use is important for monitoring potential risks and guiding safe, cost-effective prescribing. Prolonged corticosteroid use can increase the risk of adverse outcomes, including diabetes, fractures, and cardiovascular complications.
While the study lacked dispensing and adherence data, it employed standardized methods to estimate treatment persistence and coverage. The authors called for further research to refine measurement approaches and to better understand long-term corticosteroid use in patients with chronic conditions.
They reported no conflicts of interest.
Source: PDS