Systemic corticosteroid use in relation to development of corticosteroid-associated co-morbidities: a 2 year analysis of real world data in Germany

Background: Long-term treatment with oral corticosteroids (OCS) for severe asthma (SA) is still focus of debate, especially due to the variety of potential side effects. The prevalence of cumulative OCS use for > 30 days/year (d/y) is still relatively high. There is an need to investigate the impact of OCS use in SA patients related to the development of OCS-associated co-morbidities in real life.

Methods: We studied percentage of SA patients (2 diagnoses/year; classified by prescriptions to GINA treatment steps 4/5) in Germany (m/f, > 18y) identified from IMS^® database which is an electronic medical records database covering panels of 1289 general practitioners (GPs) and 28 respiratory physicians (RPs). Longitudinal observable patient data (GP/RP consultation 12 months before and following index date) in 2015 (Y1) and 2016 (Y2) were descriptively analyzed in respect to documented co-morbidities and stratified by age and specialty (GP/RP). Historical and newly documented co-morbidities of patients with OCS use > 30 d/y were compared with those of a control cohort (GINA 4/5).

Results: The greatest deviation at GPs between patients with and without continuous OCS medication is visible for the co-morbidity osteoporosis with a 14,5% (Y1) and 15,9% (Y2) higher percentage of patients with continuous OCS therapy, followed by diabetes with 8,2% (Y1) and 7,4% (Y2). At RPs the greatest deviation between patients with continuous OCS medication and patients classified as GINA 4/5 is visible for the previous co-morbidities infections with a 16,5% (Y1) and 19,4% (Y2) higher percentage. As the chance of co-morbidities increases with higher patient-age and the cohorts were not matched by patient-age, the different patient-age structure should be kept in mind while comparing distributions of co-morbidities.

Conclusion: Our descriptive analysis reveals that the percentage of patients with co-morbidities is higher for patients with continuous OCS use compared to patients with severe asthma (GINA 4/5) without continuous OCS use.