High cumulative exposure to oral corticosteroids for asthma a concern
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High cumulative exposure to oral corticosteroids for asthma a concern Cumulative dispensing of high oral corticosteroid doses reaches levels associated with long-term toxicity in a large number of patients with asthma using inhaled corticosteroids in Australia. This is the main finding of a retrospective cohort study that estimated the number and proportion of patients aged ≥ 12 years dispensed oral corticosteroids for treating asthma, while also receiving inhaled corticosteroids, during 2014–2018.* In particular, the study assessed the proportion of patients dispensed a cumulative dose of ≥ 1000mg prednisolone-equivalent over the 5-year period. The study used data from a 10% random sample of the Pharmaceutical Benefits Scheme dispensing database in Australia. The analysis of data from 124 011 patients showed that 64 112 (51.7%) had been dispensed oral corticosteroids over the 5-year period, including 34 580 (27.9%) who had been dispensed a cumulative dose of ≥ 1000mg prednisoloneequivalent. This is a level associated with long-term systemic toxicity, note the researchers. The study found that the proportions of patients dispensed medications for managing diabetes or osteoporosis were significantly higher for those who had high cumulative exposure, compared with those with lower cumulative exposure. The analysis of 12-month dispensing data during 2018 showed that cumulative high oral corticosteroid doses were often dispensed to patients whose use of inhaled corticosteroids was inadequate. "Many patients dispensed [oral corticosteroids] are not adhering to appropriate [inhaled corticosteroid] controller therapy. The need for frequent short courses or long term [oral corticosteroid] therapy is neither benign nor acceptable," conclude the researchers. * AstraZeneca provided funding for the study. Hew M, et al. Cumulative dispensing of high oral corticosteroid doses for treating asthma in Australia. Medical Journal of Australia : 9 Sep 2020. Available from: URL: http:// 803502811 doi.org/10.5694/mja2.50758
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Reactions 26 Sep 2020 No. 1823
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