P199 Adverse events profile of oral corticosteroids among asthma patients in the uk

Background and Objectives Previous studies have linked oral corticosteroid use in asthma patients to various adverse events. This study aimed to assess in more depth than has previously been done the toxicity profile of oral prednisolone among adult asthma patients. Methods Using data from the UK-based Clinical Practice Research Datalink, we conducted a series of cohort studies, each with a nested case-control analysis, to quantify the risk of 11 different potential corticosteroid-related adverse events. Results Incidence rates per 1000 person-years of potential corticosteroid-related adverse events in patients with new current use of oral prednisolone ranged from 1.4 (95% confidence interval [CI], 1.0–1.8) for peptic ulcer to 78.0 (95% CI, 74.8–81.2) for severe infections. After adjusting for confounding, current oral prednisolone use was most strongly associated with an increased risk of severe infection (odds ratio [OR] 2.16; 95% CI, 2.05–2.27) compared with non-use of prednisolone. There were smaller elevated risks of peptic ulcer (OR 1.47; 95% CI, 1.12–1.92), affective disorders (OR 1.47; 95% CI, 1.32–1.63), herpes zoster (OR 1.32; 95% CI 1.19–1.48), cardiovascular events (OR 1.33; 95% CI 1.18–1.49), diabetes mellitus type 2 (OR 1.35; 95% CI 1.22–1.49), bone related conditions (OR 1.27; 95% CI 1.17–1.37), and cataract at higher cumulative doses (cumulative dose ≥2000 mg: OR 1.43; 95% CI 1.17–1.73), compared with non-use of prednisolone. We did not observe an association between current oral prednisolone use and glaucoma, chronic kidney disease, or hypertension. Past use of oral prednisolone was not associated with any of the study outcomes. We observed possible dose-response relationships between current oral prednisolone use and the risk of cardiovascular events, affective disorders, bone-related conditions, severe infections, diabetes mellitus type 2, and cataract, but not the other investigated outcomes. Conclusion Oral prednisolone use is associated with an increased risk of infections, gastrointestinal, neuropsychiatric, ocular, cardiovascular, metabolic, and bone-related complications among adult asthma patients. The risk is associated with current but not past use of oral prednisolone use, and for some outcomes with the prescribed dose of oral prednisolone.