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Open Access Corticosteroid-related toxicity in patients with chronic idiopathic urticaria‐chronic spontaneous urticaria

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Background:

Treatments for patients with chronic idiopathic urticaria (CIU)‐chronic spontaneous urticaria (CSU) who were unresponsive to antihistamines include oral corticosteroids (OCS). Risks of OCS-related side effects in these patients have not been described quantitatively.

Objective:

To investigate the relationship between OCS use and the risk of developing side effects possibly attributable to OCS and associated health care costs in privately insured patients with CIU/CSU.

Methods:

This retrospective cohort study analyzed a commercial claims data base from January 1, 2008, to December 31, 2012. Patients with CIU/CSU were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes via a validated algorithm. Possible OCS-related side effects included the following: diabetes mellitus, hypertension, lipid disorders, cataracts, depression or mania, osteoporosis or fractures, and infectious diseases. A time-dependent Cox regression (adjusted for age, sex, Charlson Comorbidity Index, and immunomodulator use) was used to separately model cumulative oral prednisone-equivalent exposure and the risk of side effects. Incremental total adjusted health care costs were compared in patients with versus patients without possible OCS-related side effects.

Results:

Among 12,647 patients with CIU/CSU, 55.4% used OCS. An additional 1 g of prednisone-equivalent exposure was associated with a 7% increase in the likelihood of developing a possible side effect (hazard ratio, 1.07 [95% confidence interval, 1.05‐1.08]). From the period before to the period after OCS initiation, the total mean adjusted annual health care costs increased by $1833 in users of OCS with new possible side effects and decreased by $2183 in patients without new possible side effects (p < 0.001).

Conclusion:

Patients with CIU/CSU who were treated with OCS had an increased risk of possible OCS-related side effects and higher total health care costs than their counterparts not treated with OCS.

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Keywords: Adverse events; chronic idiopathic urticaria; chronic spontaneous urticaria; costs; data base analysis; health economics; oral corticosteroid; outcomes; resource utilization; toxicity

Document Type: Research Article

Affiliations: Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida and the James A. Haley Veterans’ Hospital, Tampa, Florida, USA

Publication date: November 1, 2016

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

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    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

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    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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