Trends in Systemic Glucocorticoid Utilization in the United Kingdom from 1990 to 2019: A Population-Based, Serial Cross-Sectional Analysis

Andrew N Menzies-Gow; Trung N Tran; Brooklyn Stanley; Victoria Ann Carter; Josef S Smolen; Arnaud Bourdin; J Mark Fitzgerald; Tim Raine; Jatin Chapaneri; Benjamin Emmanuel; David J Jackson; David B Price

doi:10.2147/POR.S442959

Trends in Systemic Glucocorticoid Utilization in the United Kingdom from 1990 to 2019: A Population-Based, Serial Cross-Sectional Analysis

Pragmat Obs Res. 2024 Mar 15:15:53-64. doi: 10.2147/POR.S442959. eCollection 2024.

Authors

Andrew N Menzies-Gow^{1

2}, Trung N Tran³, Brooklyn Stanley⁴, Victoria Ann Carter⁴, Josef S Smolen⁵, Arnaud Bourdin⁶, J Mark Fitzgerald⁷, Tim Raine⁸, Jatin Chapaneri², Benjamin Emmanuel³, David J Jackson^{9

10}, David B Price^{4

11}

Affiliations

¹ Royal Brompton and Harefield Hospitals, Guys & St Thomas' NHS Foundation Trust, London, UK.
² AstraZeneca, Cambridge, UK.
³ AstraZeneca, Gaithersburg, MD, USA.
⁴ Observational and Pragmatic Research Institute, Singapore.
⁵ Medical University of Vienna, Vienna, Austria.
⁶ Université de Montpellier, CHU Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France.
⁷ The University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
⁹ Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, UK.
¹⁰ School of Immunology & Microbial Sciences, King's College London, London, UK.
¹¹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Abstract

Purpose: Associations between systemic glucocorticoid (SGC) exposure and risk for adverse outcomes have spurred a move toward steroid-sparing treatment strategies. Real-world changes in SGC exposure over time, after the introduction of steroid-sparing treatment strategies, reveal areas of successful risk mitigation as well as unmet needs.

Patients and methods: A population-based ecological study was performed from the Optimum Patient Care Research Database to describe SGC prescribing trends of steroid-sparing treatment strategies in primary care practices before and after licensure of biologics in the United Kingdom from 1990 to 2019. Each analysis year included patients aged ≥5 years who were registered for ≥1 year with a participating primary care practice. The primary analysis was SGC exposure, defined as total cumulative SGC dose per patient per year, for asthma, severe asthma, chronic obstructive pulmonary disease (COPD), nasal polyps, Crohn's disease, rheumatoid arthritis, ulcerative colitis, and systemic lupus erythematosus. Secondary outcomes were percentages of patients prescribed SGCs and number of SGC prescriptions per patient per year.

Results: The number of patients who met study inclusion criteria ranged from 219,862 (1990) to 1,261,550 (2019). At the population level, patients with asthma or COPD accounted for 67.7% to 73.2% of patients per year with an SGC prescription. Over three decades, decreases in SGC total yearly dose ≥1000 mg have been achieved in multiple conditions. Patients with COPD prescribed SGCs increased from 5.8% (1990) to 34.8% (2017). SGC prescribing trends for severe asthma, Crohn's disease, and ulcerative colitis show decreased prescribing trends after the introduction of biologics.

Conclusion: Decreases in total yearly SGC doses have been shown in multiple conditions; however, for conditions such as severe asthma and COPD, an unmet need remains for increased awareness of SGC burden and the adoption or development of SGC-sparing alternatives to reduce overuse.

Keywords: biological products; drug prescriptions; drug utilization; glucocorticoids; practice patterns.

Grants and funding

This work was funded by AstraZeneca. In collaboration with the steering committee, AstraZeneca was involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the article for publication. All authors had full access to the data, agreed to be accountable for the accuracy and integrity of the work, and shared responsibility for the decision to submit the article for publication. Steering committee members were not compensated for their participation.