Objective:

To investigate the association between annual oral corticosteroid exposure and systemic adverse events in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

Approach:

• Study Design: A nationwide nested case-control study using data from the Korean Health Insurance Review and Assessment Service database from 2010 to 2023.
• Cohort Description: Included 165,361 adult patients diagnosed with CRSwNP who received at least one oral corticosteroid prescription, excluding those with prior immune-mediated inflammatory diseases or prior adverse event diagnoses.
• Data Analysis: Matched analysis included 51,647 case patients and 472,369 controls, assessing oral corticosteroid exposure based on annual treatment duration, cumulative prednisolone-equivalent dose, and prescription frequency.

Key Findings:

• Patients receiving at least 1.0 g of prednisolone-equivalent oral corticosteroids per year had 23% higher adjusted odds of any systemic adverse event compared to those receiving less than 0.5 g per year.
• Adverse-event-specific analyses showed 2.6 times the odds of avascular bone necrosis and 1.5 times the odds of pneumonia in patients receiving at least 1.0 g/year.
• Patients receiving oral corticosteroids for more than 90 days per year had higher adjusted odds of avascular bone necrosis, osteoporosis, and pneumonia.

Interpretation:

Limitations:

• Observational design and reliance on administrative claims data from a single national health care system may limit generalizability.
• Inability to assess CRSwNP severity, asthma severity, exact clinical indications for prescriptions, medication adherence, and over-the-counter steroid use.
• Residual confounding may remain despite matching and statistical adjustments.

Conclusion:

Sources:

• JAMA Otolaryngology–Head & Neck Surgery