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Systemic glucocorticosteroids (SGCs) are recommended only for short-term treatment of atopic dermatitis (AD) because of their side effect profile. Nevertheless, prolonged and repeated use remains common in routine care. Evidence on whether treatment duration or cumulative dose is the main driver of adverse events is limited. Therefore, the aim of this study is to investigate the longitudinal association between SGC treatment duration and side effects in persons with AD and to compare its impact with cumulative dose. This was a retrospective cohort study based on German statutory health insurance data that included persons with AD initiating SGC therapy. Associations between SGC exposure and side effect were analyzed using logistic regression and adjusted time-dependent Cox models. Longer treatment duration was associated with higher odds of multiple side effects, including osteoporosis (odds ratio OR 1.21–1.27). In time-dependent Cox models, each additional quarter of SGC therapy increased the hazard of mental disorders (hazard ratio HR 1.21; 95% confidence interval CI 1.10–1.32), gastritis/duodenitis (HR 1.07; 1.00–1.15), osteoporosis (HR 1.37; 1.23–1.52), hypertension (HR 1.26; 1.08–1.48), and diabetes mellitus (HR 1.35; 1.09–1.69). Prolonged SGC therapy is associated with increasing risks of multiple side effects, supporting guideline recommendations for short-term use only. Documented SGC treatment duration showed more consistent associations with side effects than cumulative dose. Atopic dermatitis is a chronic skin condition characterized by itching and inflammation, which can occur in flare-ups. It is estimated that around 3.6 million persons in Germany are affected by atopic dermatitis. Systemic glucocorticosteroids are a widely used medication for the treatment of atopic dermatitis, but owing to their many side effects, they should only be used for short-term treatment. Contrary to this recommendation, however, studies show that prescriptions are often longer than necessary. This study therefore examines the duration and dosage of systemic glucocorticosteroid prescriptions, as well as the associated risk of side effects, in individuals with atopic dermatitis. To this end, we evaluated anonymized billing data from a large German health insurance company, including persons with atopic dermatitis who received a new systemic glucocorticosteroid prescription. Our findings show that the length of systemic glucocorticosteroid treatment mattered more for adverse events than the total amount prescribed. Thus, we observed persons with atopic dermatitis and systemic glucocorticosteroid prescriptions until new side effects occurred. The longer individuals took systemic glucocorticosteroids, the more frequently side effects occurred. This was particularly evident in cases of gastritis/duodenitis, osteoporosis, high blood pressure, and diabetes. Our findings support the systemic glucocorticosteroid prescription recommendation and show that the duration of systemic glucocorticosteroid therapy has a great impact in adverse events. However, a short-term prescription for severe acute flare-ups can be helpful. Other systemic therapies are recommended for long-term treatment.
Klinger et al. (Mon,) studied this question.