Corticosteroids Pose Toxicity Risk for Patients with Chronic Idiopathic Urticaria

Patients who have either chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU) who take oral corticosteroids (OCS) face a greater risk of side effects as well as higher total healthcare costs, according to a recent study.

Although treatment guidelines call for a short course of corticosteroids when a nonsedating H1 antihistamine fails to control urticaria, the authors point out that “Although the clinical community often relies on the shortest course of corticosteroid treatment, urticaria may flare when treatment is discontinued, which necessitates additional courses.” Using OCSs longer-term can lead to increased side effects and greater costs.

“The aim of this study was to examine the relationship between OCS use and the risk of developing side effects possibly attributed to corticosteroid use in privately insured patients with CIU/CSU,” say the authors. In order to meet that goal, they conducted a retrospective cohort study using claims data.

The researchers identified 12,647 patients with CIU or CSU. They matched those who used OCS during the baseline period with those who did not “with respect to age, sex and the number of chronic conditions,” they say. Under the heading “Outcomes of Interest” the researchers note that 58.5% of the patients experienced at least one side effect. Furthermore, they say, “In the study period, as prednisone-equivalent OCS exposure increased, so did the risk of developing a possible side effect.”

In addition to more side effects, those same patients experienced higher costs. The researchers report, “From the baseline period to the post-index period, the mean unadjusted total health care costs decreased in patients without possible OCS-related side effects.” They do caution that the results should be interpreted within the context of the study’s limitations, saying, “The effects of confounding factors, such as the differences in the severity of CIU/CSU, could not be fully controlled.” They also note the confirmation of diagnoses was not possible.

Published in Allergy and Asthma Proceedings, the study was conducted by Dennis Ledford, MD, of the Department of Medicine, Division of Allergy and Immunology at Morsani College of Medicine at the University of South Florida, and colleagues.

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