Treatment persistence and variations in prescribing oral, injectable, and inhaled corticosteroids: a population-based drug utilisation study

Domzaridou, Eleni, Carr, Matthew J., Williams, David M. ORCID: https://orcid.org/0000-0002-7351-5131, Avery, Anthony J., Van Staa, Tjeerd, Rees, Aled ORCID: https://orcid.org/0000-0002-1165-9092 and Ashcroft, Darren M. 2025. Treatment persistence and variations in prescribing oral, injectable, and inhaled corticosteroids: a population-based drug utilisation study. Pharmacoepidemiology & Drug Safety 34 (5) , e70153. 10.1002/pds.70153

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Abstract

Purpose: To examine variation in oral, injectable, and inhaled corticosteroid (CS) prescribing in primary care, exploring treatment persistence and coverage. Methods: We examined patient-level electronic health records from English general practices in the Clinical Practice Research Datalink Aurum database. We delineated a cohort of new users of oral, injectable, or inhaled CS with prescriptions issued between January 1, 2000, and June 30, 2021. Lorenz curves assessed potential prescribing skewness, and Kaplan–Meier (KM) plots estimated treatment persistence. The Proportion of Patients Covered (PPC) method estimated the proportion of patients still covered by treatment 1 year after initiation. Results: We observed 1 942 571 CS users across 1471 general practices, with 20% of oral and inhaled CS users accounting for almost 80% of total CS use. Older patients with comorbidities including respiratory diseases (13.5%), skin conditions (5.8%), or inflammatory bowel diseases (1.6%) were more likely to be prescribed higher doses. The KM plots showed that 20% of oral and 50% of inhaled CS users were persistent after one and 2 months, respectively. The PPC method indicated that 30% of oral and 60% of inhaled CS users were covered by treatment 6 months post-initiation. Some variation was observed when different grace periods were applied. Combined use of oral and inhaled CS was observed for 6.9% of patients. Conclusion: A fifth of patients receiving CS accounted for over 80% of oral and inhaled CS prescribing in primary care. Identifying these patients is crucial for targeting future interventions to promote patient safety and cost-effective CS use.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Wiley
ISSN:	1053-8569
Date of First Compliant Deposit:	20 May 2025
Date of Acceptance:	11 April 2025
Last Modified:	20 May 2025 11:30
URI:	https://orca.cardiff.ac.uk/id/eprint/177889

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