Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study


Autoři: Kueiyu Joshua Lin aff001;  Evan Dvorin aff003;  Aaron S. Kesselheim aff001
Působiště autorů: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America aff001;  Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America aff002;  Ochsner Health System, Jefferson Parish, Louisiana, United States of America aff003
Vyšlo v časopise: Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003058
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003058

Souhrn

Background

Evidence and guidelines do not support use of systemic steroids for acute respiratory tract infections (ARTIs), but such practice appears common. We aim to quantify such use and determine its predictors.

Methods and findings

We conducted a cohort study based on a large United States national commercial claims database, the IBM MarketScan, to identify patients aged 18–64 years with an ARTI diagnosis (acute bronchitis, sinusitis, pharyngitis, otitis media, allergic rhinitis, influenza, pneumonia, and unspecified upper respiratory infections) recorded in ambulatory visits from 2007 to 2016. We excluded those with systemic steroid use in the prior year and an extensive list of steroid-indicated conditions, including asthma, chronic obstructive pulmonary disease, and various autoimmune diseases. We calculated the proportion receiving systemic steroids within 7 days of the ARTI diagnosis and determined its significant predictors. We identified 9,763,710 patients with an eligible ARTI encounter (mean age 39.6, female 56.0%) and found 11.8% were prescribed systemic steroids (46.1% parenteral, 47.3% oral, 6.6% both). All ARTI diagnoses but influenza predicted receiving systemic steroids. There was high geographical variability: the adjusted odds ratio (aOR) of receiving parenteral steroids was 14.48 (95% confidence interval [CI] 14.23–14.72, p < 0.001) comparing southern versus northeastern US. The corresponding aOR was 1.68 (95% CI 1.66–1.69, p < 0.001) for oral steroids. Other positive predictors for prescribing included emergency department (ED) or urgent care settings (versus regular office), otolaryngologist/ED doctors (versus primary care), fewer comorbidities, and older patient age. There was an increasing trend from 2007 to 2016 (aOR 1.93 [95% CI 1.91–1.95] comparing 2016 to 2007, p < 0.001). Our findings are based on patients between 18 and 64 years old with commercial medical insurance and may not be generalizable to older or uninsured populations.

Conclusions

In this study, we found that systemic steroid use in ARTI is common with a great geographical variability. These findings call for an effective education program about this practice, which does not have a clear clinical net benefit.

Klíčová slova:

Critical care and emergency medicine – Outpatients – Physicians – Pneumonia – Respiratory infections – Steroid therapy – Steroids – Pharyngitis


Zdroje

1. Adult Treatment Recommendations. CDC. 2017 [cited 2019 Jan 4]. Available from: https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html.

2. Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam Physician. 2010;82(11):1345–50. Epub 2010/12/03. 21121518.

3. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153–9. Epub 2012/09/12. 22962927.

4. Hay AD, Little P, Harnden A, Thompson M, Wang K, Kendrick D, et al. Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection: A Randomized Clinical Trial. JAMA. 2017;318(8):721–30. Epub 2017/08/23. doi: 10.1001/jama.2017.10572 28829884; PubMed Central PMCID: PMC5817483.

5. Hayward G, Thompson MJ, Perera R, Del Mar CB, Glasziou PP, Heneghan CJ. Corticosteroids for the common cold. Cochrane Database Syst Rev. 2015;(10):CD008116. Epub 2015/10/16. doi: 10.1002/14651858.CD008116.pub3 26461493.

6. Francis NA, Cannings-John R, Waldron CA, Thomas-Jones E, Winfield T, Shepherd V, et al. Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial. Lancet. 2018;392(10147):557–68. Epub 2018/08/29. doi: 10.1016/S0140-6736(18)31490-9 30152390; PubMed Central PMCID: PMC6099122.

7. Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ. 2017;358:j3887. Epub 2017/09/22. doi: 10.1136/bmj.j3887 28931508; PubMed Central PMCID: PMC5605780.

8. Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev. 2014;(3):CD008115. Epub 2014/03/26. doi: 10.1002/14651858.CD008115.pub3 24664368.

9. Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AG. Short-course oral steroids alone for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011991. Epub 2016/04/27. doi: 10.1002/14651858.CD011991.pub2 27113367.

10. Waljee AK, Rogers MA, Lin P, Singal AG, Stein JD, Marks RM, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. Epub 2017/04/14. doi: 10.1136/bmj.j1415 28404617.

11. Dvorin EL, Lamb MC, Monlezun DJ, Boese AC, Bazzano LA, Price-Haywood EG. High Frequency of Systemic Corticosteroid Use for Acute Respiratory Tract Illnesses in Ambulatory Settings. JAMA Intern Med. 2018;178(6):852–4. Epub 2018/02/27. doi: 10.1001/jamainternmed.2018.0103 29482204; PubMed Central PMCID: PMC5885155.

12. West SL, Savitz DA, Koch G, Strom BL, Guess HA, Hartzema A. Recall accuracy for prescription medications: self-report compared with database information. Am J Epidemiol. 1995;142(10):1103–12. Epub 1995/11/15. doi: 10.1093/oxfordjournals.aje.a117563 7485055.

13. Levy AR, O'Brien BJ, Sellors C, Grootendorst P, Willison D. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol. 2003;10(2):67–71. Epub 2003/07/25. 12879144.

14. West SL, Strom BL, Freundlich B, Normand E, Koch G, Savitz DA. Completeness of prescription recording in outpatient medical records from a health maintenance organization. J Clin Epidemiol. 1994;47(2):165–71. Epub 1994/02/01. doi: 10.1016/0895-4356(94)90021-3 8113825.

15. Tamariz L, Harkins T, Nair V. A systematic review of validated methods for identifying venous thromboembolism using administrative and claims data. Pharmacoepidemiol Drug Saf. 2012;21 Suppl 1:154–62. Epub 2012/01/25. doi: 10.1002/pds.2341 22262602.

16. Patorno E, Pawar A, Franklin JM, Najafzadeh M, Deruaz-Luyet A, Brodovicz KG, et al. Empagliflozin and the Risk of Heart Failure Hospitalization in Routine Clinical Care. Circulation. 2019;139(25):2822–30. Epub 2019/04/09. doi: 10.1161/CIRCULATIONAHA.118.039177 30955357; PubMed Central PMCID: PMC6594384.

17. Selby J, Reichman ME, Graham D, Butler M, Hampp C, Levenson M, Southworth MR, Toh D, Fireman B. MINI-SENTINEL MEDICAL PRODUCT ASSESSMENT: A PROTOCOL FOR ACTIVE SURVEILLANCE OF ACUTE MYOCARDIAL INFARCTION IN ASSOCIATION WITH USE OF ANTI-DIABETIC AGENTS. 2016 [cited 2019 Nov 19]. Available from: https://www.sentinelinitiative.org/sites/default/files/Drugs/Assessments/Mini-Sentinel_AMI-and-Anti-Diabetic-Agents_Protocol.pdf.

18. Jafri K, Taylor L, Nezamzadeh M, Baker JF, Mehta NN, Bartels C, et al. Management of hyperlipidemia among patients with rheumatoid arthritis in the primary care setting. BMC Musculoskelet Disord. 2015;16:237. Epub 2015/09/05. doi: 10.1186/s12891-015-0700-5 26336889; PubMed Central PMCID: PMC4559905.

19. Gagne JJ, Glynn RJ, Avorn J, Levin R, Schneeweiss S. A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol. 2011;64(7):749–59. Epub 2011/01/07. doi: 10.1016/j.jclinepi.2010.10.004 21208778; PubMed Central PMCID: PMC3100405.

20. Scott JR, Ernst HM, Rotenberg BW, Rudmik L, Sowerby LJ. Oral corticosteroid prescribing habits for rhinosinusitis: The American Rhinologic Society membership. Am J Rhinol Allergy. 2017;31(1):22–6. Epub 2017/02/25. doi: 10.2500/ajra.2017.31.4396 28234148.

21. Wang SV, Verpillat P, Rassen JA, Patrick A, Garry EM, Bartels DB. Transparency and Reproducibility of Observational Cohort Studies Using Large Healthcare Databases. Clin Pharmacol Ther. 2016;99(3):325–32. Epub 2015/12/23. doi: 10.1002/cpt.329 26690726.

22. Fralick M, Schneeweiss S, Patorno E. Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor. N Engl J Med. 2017;376(23):2300–2. Epub 2017/06/08. doi: 10.1056/NEJMc1701990 28591538.

23. Kim SC, Solomon DH, Rogers JR, Gale S, Klearman M, Sarsour K, et al. Cardiovascular Safety of Tocilizumab Versus Tumor Necrosis Factor Inhibitors in Patients With Rheumatoid Arthritis: A Multi-Database Cohort Study. Arthritis Rheumatol. 2017;69(6):1154–64. Epub 2017/03/01. doi: 10.1002/art.40084 28245350; PubMed Central PMCID: PMC5573926.

24. VanderWeele TJ, Ding P. Sensitivity Analysis in Observational Research: Introducing the E-Value. Ann Intern Med. 2017;167(4):268–74. Epub 2017/07/12. doi: 10.7326/M16-2607 28693043.

25. Hersh AL, Shapiro DJ, Pavia AT, Fleming-Dutra KE, Hicks LA. Geographic Variability in Diagnosis and Antibiotic Prescribing for Acute Respiratory Tract Infections. Infect Dis Ther. 2018;7(1):171–4. Epub 2017/12/24. doi: 10.1007/s40121-017-0181-y 29273976; PubMed Central PMCID: PMC5840100.

26. Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2017;12:CD007720. Epub 2017/12/14. doi: 10.1002/14651858.CD007720.pub3 29236286.

27. Da Silva JA, Jacobs JW, Kirwan JR, Boers M, Saag KG, Ines LB, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis. 2006;65(3):285–93. Epub 2005/08/19. doi: 10.1136/ard.2005.038638 16107513; PubMed Central PMCID: PMC1798053.

28. Hoes JN, Jacobs JW, Boers M, Boumpas D, Buttgereit F, Caeyers N, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007;66(12):1560–7. Epub 2007/07/31. doi: 10.1136/ard.2007.072157 17660219; PubMed Central PMCID: PMC2095301.

29. Uppalapati SS, Boylan JD, Stoltzfus J. Risk factors involved in patients with bleeding peptic ulcers: a case-control study. Dig Dis Sci. 2009;54(3):593–8. Epub 2008/07/24. doi: 10.1007/s10620-008-0387-7 18648934.

30. Leibovici L. Bacteraemia in the very old. Features and treatment. Drugs Aging. 1995;6(6):456–64. Epub 1995/06/01. doi: 10.2165/00002512-199506060-00005 7663065.

31. Montagnana M, Favaloro EJ, Franchini M, Guidi GC, Lippi G. The role of ethnicity, age and gender in venous thromboembolism. J Thromb Thrombolysis. 2010;29(4):489–96. Epub 2009/06/19. doi: 10.1007/s11239-009-0365-8 19536458.

32. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12(12):989–95. Epub 2002/02/16. doi: 10.1007/s001980170006 11846333.

33. Choudhry NK, Shrank WH. Four-dollar generics—increased accessibility, impaired quality assurance. N Engl J Med. 2010;363(20):1885–7. Epub 2010/11/12. doi: 10.1056/NEJMp1006189 21067379

34. Zgierska A, Rabago D, Miller MM. Impact of patient satisfaction ratings on physicians and clinical care. Patient Prefer Adherence. 2014;8:437–46. Epub 2014/04/15. doi: 10.2147/PPA.S59077 24729691; PubMed Central PMCID: PMC3979780.


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