Targeted Literature Review and Qualitative Synthesis of the Burden of Oral Corticosteroid-Related Adverse Events in Autoimmune Conditions
Author(s)
John H. Stone, MD1, Syed Raza, MSc2, David Proudman, MPH3, sydney ng, MPH3, Arshya Feizi, PhD3, Adrienne Kwok, MPH3, Noam Kirson, PhD3, Glenn Phillips, PhD2.
1Mass General Rheumatology, Massachusetts General Hospital, Boston, MA, USA, 2Argenx, Boston, MA, USA, 3Analysis Group, Boston, MA, USA.
1Mass General Rheumatology, Massachusetts General Hospital, Boston, MA, USA, 2Argenx, Boston, MA, USA, 3Analysis Group, Boston, MA, USA.
Presentation Documents
OBJECTIVES: Patients with autoimmune conditions are often managed with oral corticosteroids (OCS) for long durations, often at relatively high doses. However, there is relatively little up-to-date information on the clinical and economic burden of OCS use. A targeted review was conducted to evaluate recent literature and current data gaps to understand the types and rates of adverse events (AEs) associated with long-term OCS use in autoimmune conditions.
METHODS: Studies published between January 2017-October 2024 were identified searching Embase, MEDLINE, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, and Health Technology Assessment Database. Search strategy informed by clinical input included terms for corticosteroids, autoimmune conditions, and AEs. A supplementary hand search was conducted. Publications were restricted to systematic reviews (SLR), meta-analyses (MA), high-quality reviews, or real-world analyses among adults with autoimmune conditions with long-term OCS use.
RESULTS: The search yielded 71 articles, of which 21 met inclusion criteria (10 SLR/MA; 11 other methodology). AEs reported across multiple studies included: infections, induced hormonal dysfunction, bone, ocular, gastrointestinal, cardiovascular, metabolic, and psychiatric events. OCS-related AE incidence varied by dose and/or duration of treatment, age and gender, with reported hazard ratio ranges for OCS use vs no OCS use, including: fractures (1.1-1.5), diabetes (1.2-2.9), depression (1.3-2.6), hypertension (1.3-2.2) and cataracts (1.7-2.0). Reported costs per AE episode were as high as $31,902 for peptic ulcer and $38,695 (inflated to 2024 USD) for nonfatal myocardial infarction. Studies also reported associations between OCS use and increased total costs, healthcare resource utilization, infection-related hospitalizations, and mortality, as well as decreased quality-of-life.
CONCLUSIONS: OCS use is linked to a range of AEs including severe and life-threatening conditions, with an important clinical and economic burden. Further research is needed to quantify the cost and quality-of-life impact of long-term OCS-related AEs among patients with autoimmune conditions.
METHODS: Studies published between January 2017-October 2024 were identified searching Embase, MEDLINE, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, and Health Technology Assessment Database. Search strategy informed by clinical input included terms for corticosteroids, autoimmune conditions, and AEs. A supplementary hand search was conducted. Publications were restricted to systematic reviews (SLR), meta-analyses (MA), high-quality reviews, or real-world analyses among adults with autoimmune conditions with long-term OCS use.
RESULTS: The search yielded 71 articles, of which 21 met inclusion criteria (10 SLR/MA; 11 other methodology). AEs reported across multiple studies included: infections, induced hormonal dysfunction, bone, ocular, gastrointestinal, cardiovascular, metabolic, and psychiatric events. OCS-related AE incidence varied by dose and/or duration of treatment, age and gender, with reported hazard ratio ranges for OCS use vs no OCS use, including: fractures (1.1-1.5), diabetes (1.2-2.9), depression (1.3-2.6), hypertension (1.3-2.2) and cataracts (1.7-2.0). Reported costs per AE episode were as high as $31,902 for peptic ulcer and $38,695 (inflated to 2024 USD) for nonfatal myocardial infarction. Studies also reported associations between OCS use and increased total costs, healthcare resource utilization, infection-related hospitalizations, and mortality, as well as decreased quality-of-life.
CONCLUSIONS: OCS use is linked to a range of AEs including severe and life-threatening conditions, with an important clinical and economic burden. Further research is needed to quantify the cost and quality-of-life impact of long-term OCS-related AEs among patients with autoimmune conditions.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH133
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)