ArticleJournal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
Systemic Corticosteroid Dispensing Patterns Among Patients with Sinonasal Polyps: A Population-Based Retrospective Cohort Study.
Article in Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
importanceSystemic corticosteroids (SCS) are widely prescribed for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), yet no strict guidelines standardize their use. While data-specific to CRSwNP remains limited, growing evidence from lower respiratory disease supports a dose-response relationship between SCS use and related adverse outcomes that begin at relatively low cumulative doses. Reporting on SCS use among patients with CRSwNP is crucial to better understand prescribing patterns and inform future assessments of potential risks.
objectiveThis study investigates dispensing patterns of SCS among CRSwNP patients.
designA population-based retrospective cohort study of community-based pharmacy claims data. The study period was between January 1, 2012 and December 31, 2022.
settingThe province of British Columbia, Canada, home of approximately 5 million residents.
participantsInsured residents diagnosed with CRSwNP and at least 2 years of data on dispenses. EXPOSURES: SCS dispenses were identified for all cohort members.
main outcome measuresCumulative SCS doses were calculated. Dispensed SCS courses were characterized based on administration method, dose, course length, and prescriber specialties. Prednisone prescribing patterns were evaluated.
resultsA total of 7000 patients diagnosed with CRSwNP were included in the cohort. Among them, 1527 (21.8%) received 1 gram or more of SCS, an exposure level that has been associated with an increased risk of adverse outcomes in studies of lower respiratory diseases. High cumulative SCS exposure was more common among patients residing in rural areas and those with comorbid respiratory conditions. The mean SCS per patient per year (PPPY) dose was 212.6 mg (SD: 438.2), lower than figures reported in other countries. General practitioners were the most frequent prescribers overall, including among patients without asthma. Otolaryngologists were the second most common prescribers and demonstrated inconsistent prednisone prescribing practices over the study period.
conclusionsPopulation-based dispensing data showed unwarranted variation in SCS dispensing among CRSwNP patients, which may contribute to differential exposure to SCS-related adverse outcomes. RELEVANCE: There is a need for clear clinical guidelines to standardize SCS exposure among CRSwNP patients, optimize treatment, and support more consistent and appropriate SCS use.
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