Changes in oral corticosteroid use in asthma treatment—A 20-year Danish nationwide drug utilisation study

Inge Raadal Skov, Daniel Pilsgaard Henriksen, Hanne Madsen, Anton Pottegård, Jesper Rømhild Davidsen

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Abstract

Oral corticosteroids (OCS) are used in asthma management but can cause serious adverse effects. We aimed to investigate the usage trends in a nationwide asthma cohort in Denmark from 1999 to 2018. Using national registers, we identified young adults (18–45 years) with two or more asthma drug collections within 12 months since the age of 15 years as indicative of active asthma. OCS exposure level was stratified as high use (≥5 mg prednisolone/day/year) and low use (<5 mg/day/year). Lorenz curves were computed to illustrate potential skewness of consumption among the OCS users. We identified 318 950 individuals with a median age of 29 years (IQR 20–38 years) whereof 57% were women. The 1-year prevalence of OCS users was stable at 4.8% (median, IQR 4.7%–4.8%), but with nearly 40% decrease in high-users from 0.54% in 1999 to 0.33% in 2018. The median annual exposure decreased from 500 mg/year (1999) to 250 mg/year (2018). We found a substantial skewness in the distribution of OCS usage with 10% of users accounting for almost 50% of all OCS use. The prevalence of OCS users among young adults with active asthma has been relatively stable from 1999 to 2018, but with a decreasing prevalence of high-users and annual consumption.

Original languageEnglish
JournalBasic & Clinical Pharmacology & Toxicology
Volume130
Issue number1
Pages (from-to)122-131
ISSN1742-7843
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
The authors would like to express our most pronounced gratitude to Jacob Harbo Andersen, Department of Public Health, University of Southern Denmark, for his invaluable help with data management. This study was funded by grants from AstraZeneca, the Odd Fellow Lodge of Haderslev Denmark, the Region of Southern Denmark and the University of Southern Denmark. The study was conducted and submitted without influence of any sponsors.

Funding Information:
IRS reports grants paid to her institution from AstraZeneca, Teva, Novartis, the Odd Fellow Lodge of Haderslev Denmark, the Region of Southern Denmark and the University of Southern Denmark and personal fees for lectures from Roche, outside the submitted work. Anton Pottegård reports participation in research projects funded by Alcon, Almirall, Astellas, AstraZeneca, Boehringer‐Ingelheim, Novo Nordisk, Servier and LEO Pharma, all regulator‐mandated phase IV studies, all with funds paid to the institution where he was employed (no personal fees) and with no relation to the work reported in this paper. JRD reports grants and personal fees for advisory board participation and lectures from Roche and Boehringer Ingelheim and personal fees for lectures from Chiesi, outside the submitted work. HM and DPH have nothing to disclose.

Keywords

  • adults
  • asthma
  • drug utilisation
  • glucocorticoids
  • pharmacoepidemiology

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