Transient Oral Corticosteroid Use and Acute Upper Gastrointestinal Bleeding in Mild-to-Moderate Asthma: A Case-Crossover Study.

backgroundSustained exposure to oral corticosteroids (OCS) increases the risk of upper gastrointestinal bleeding (UGIB). It is uncertain whether short-term OCS treatment of asthma exacerbations increases this risk. This study aims to estimate the risk of acute UGIB after transient OCS use in patients with mild-to-moderate asthma.

methodsWe used a case-crossover design within a cohort of patients with mild-to-moderate asthma, aged 18-40 years during 2000-2023, from the UK's Clinical Practice Research Datalink. Subjects who experienced a first severe UGIB formed the case series. Short-term OCS was defined by a prescription for ≤ 14 days, with a 30-day residual effect period. For each case, the UGIB event date and 6 control dates, selected at 45-day intervals in the prior year, were considered exposed if the prescription spanned the date. The odds ratio (OR) of UGIB was estimated using conditional logistic regression, adjusted for time-varying use of asthma inhalers and medications related to bleeding risks. Findings The cohort involved 655,217 patients with mild-to-moderate asthma, with 743 experiencing a first UGIB who received 1160 OCS prescriptions in the past year. The crude and adjusted ORs of UGIB after OCS use versus non-use was 1.12 (95% confidence interval [CI]: 0.92-1.37), and 1.12 (95% CI: 0.91-1.36), respectively. Higher OCS-related UGIB risk was observed during periods of no inhaled corticosteroid (ICS) use, but not during periods of regular ICS use.

conclusionShort-term OCS use does not increase UGIB risk in patients with mild-to-moderate asthma. There may be interaction between OCS and ICS in affecting UGIB risk in this patient population.