Corticosteroid-Associated Adverse Events in Chronic Spontaneous Urticaria: A US Claims Data Study

INTRODUCTION: Chronic spontaneous urticaria (CSU) is a skin disorder for which short-course systemic corticosteroids are recommended only as rescue medication during acute exacerbations. Here, we describe real-world corticosteroid use, adverse events (AEs) occurring post-corticosteroid initiation, and health care resource utilization (HCRU) of patients with CSU in the USA. METHODS: This retrospective cohort study used data from the US HealthVerity claims database of adults with diagnosed CSU (January 2016-March 2023). Only prescription and non-antihistamine claims were included in the analysis of treatment patterns. In the AE and HCRU analyses, patients were stratified into five cohorts on the basis of total days of systemic corticosteroid supply as a proxy for duration of use: ≤ 31 days, > 31 to ≤ 60 days, > 60 days, ≥ 90 days (subcohort of > 60 days), and non-corticosteroid users. RESULTS: Of 200,298 patients, corticosteroids were the most prescribed treatment (78.3% all; 68.2% systemic) following CSU diagnosis, excluding over-the-counter medication and antihistamines. The ten most common AEs occurring after systemic corticosteroid initiation (hypertension, lipid disorders, anxiety, obesity, fatigue, depression, diabetes, insomnia, cataracts, and gastritis) occurred in higher proportions of all corticosteroid user types versus non-users. The proportion of patients experiencing AEs generally increased with longer duration of corticosteroid use. More frequent HCRU was generally observed after the first systemic corticosteroid prescription and with increasing duration of corticosteroid use. CONCLUSIONS: Patients with CSU who were prescribed corticosteroids reported a higher proportion of AEs and more frequent HCRU than those who were not. These trends in AEs and HCRU were more prominent with increasing duration of corticosteroid use.