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Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario.
Matthewman, Julian; Tadrous, Mina; Mansfield, Kathryn E; Thiruchelvam, Deva; Redelmeier, Donald A; Cheung, Angela M; Lega, Iliana C; Prieto-Alhambra, Daniel; Cunliffe, Lawrence A; Mulick, Amy; Henderson, Alasdair; Langan, Sinéad M; Drucker, Aaron M.
Afiliação
  • Matthewman J; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
  • Tadrous M; Women's College Research Institute, Women's College Hospital, Toronto, Canada.
  • Mansfield KE; Leslie Dan School of Pharmacy, University of Toronto, Toronto, Canada.
  • Thiruchelvam D; ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada.
  • Redelmeier DA; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
  • Cheung AM; ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada.
  • Lega IC; ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada.
  • Prieto-Alhambra D; Department of Medicine, University of Toronto, Toronto, Canada.
  • Cunliffe LA; Department of Medicine, University of Toronto, Toronto, Canada.
  • Mulick A; Women's College Research Institute, Women's College Hospital, Toronto, Canada.
  • Henderson A; ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada.
  • Langan SM; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
  • Drucker AM; Independent Patient Partner, Canada.
JAMA Dermatol ; 159(9): 961-969, 2023 09 01.
Article em En | MEDLINE | ID: mdl-37556153
ABSTRACT
Importance Identifying and mitigating modifiable gaps in fracture preventive care for people with relapsing-remitting conditions such as eczema, asthma, and chronic obstructive pulmonary disease who are prescribed high cumulative oral corticosteroid doses may decrease fracture-associated morbidity and mortality.

Objective:

To estimate the association between different oral corticosteroid prescribing patterns and appropriate fracture preventive care, including treatment with fracture preventive care medications, among older adults with high cumulative oral corticosteroid exposure. Design, Setting, and

Participants:

This cohort study included 65 195 participants with UK electronic medical record data from the Clinical Practice Research Datalink (January 2, 1998, to January 31, 2020) and 28 674 participants with Ontario, Canada, health administrative data from ICES (April 1, 2002, to September 30, 2020). Participants were adults 66 years or older with eczema, asthma, or chronic obstructive pulmonary disease receiving prescriptions for oral corticosteroids with cumulative prednisolone equivalent doses of 450 mg or higher within 6 months. Data were analyzed October 22, 2020, to September 6, 2022. Exposures Participants with prescriptions crossing the 450-mg cumulative oral corticosteroid threshold in less than 90 days were classified as having high-intensity prescriptions, and participants crossing the threshold in 90 days or more as having low-intensity prescriptions. Multiple alternative exposure definitions were used in sensitivity analyses. Main Outcomes and

Measures:

The primary outcome was prescribed fracture preventive care. A secondary outcome was major osteoporotic fracture. Individuals were followed up from the date they crossed the cumulative oral corticosteroid threshold until their outcome or the end of follow-up (up to 1 year after index date). Rates were calculated for fracture preventive care and fractures, and hazard ratios (HRs) were estimated from Cox proportional hazards regression models comparing high- vs low-intensity oral corticosteroid prescriptions.

Results:

In both the UK cohort of 65 195 participants (mean [IQR] age, 75 [71-81] years; 32 981 [50.6%] male) and the Ontario cohort of 28 674 participants (mean [IQR] age, 73 [69-79] years; 17 071 [59.5%] male), individuals with high-intensity oral corticosteroid prescriptions had substantially higher rates of fracture preventive care than individuals with low-intensity prescriptions (UK 134 vs 57 per 1000 person-years; crude HR, 2.34; 95% CI, 2.19-2.51, and Ontario 73 vs 48 per 1000 person-years; crude HR, 1.49; 95% CI, 1.29-1.72). People with high- and low-intensity oral corticosteroid prescriptions had similar rates of major osteoporotic fractures (UK crude rates, 14 vs 13 per 1000 person-years; crude HR, 1.07; 95% CI, 0.98-1.15 and Ontario crude rates, 20 vs 23 per 1000 person-years; crude HR, 0.87; 95% CI, 0.79-0.96). Results from sensitivity analyses suggested that reaching a high cumulative oral corticosteroid dose within a shorter time, with fewer prescriptions, or with fewer or shorter gaps between prescriptions, increased fracture preventive care prescribing.

Conclusions:

The results of this cohort study suggest that older adults prescribed high cumulative oral corticosteroids across multiple prescriptions, or with many or long gaps between prescriptions, may be missing opportunities for fracture preventive care.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Asma / Doença Pulmonar Obstrutiva Crônica / Eczema / Fraturas por Osteoporose Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte / Europa Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Asma / Doença Pulmonar Obstrutiva Crônica / Eczema / Fraturas por Osteoporose Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte / Europa Idioma: En Ano de publicação: 2023 Tipo de documento: Article