Background: Systemic glucocorticosteroids (SGCs) are used in the short-term treatment of atopic dermatitis (AD), but are not recommended for long-term use because they are associated with severe side-effects.
Objectives: This study aimed to characterize the utilization and potentially negative effects of SGC use for AD in German statutory health insurance (SHI) claims data.
Methods: Cross-sectional and longitudinal analysis of a large nationwide SHI dataset. SGC drug prescriptions and incidences of predefined comorbidities after drug initiation that were known to be potentially harmful side-effects were analysed. SGC use was quantified by (-definition 1) the number of quarters with at least one SGC prescription and (definition 2) the defined daily doses (DDD). Comparisons were adjusted for age, sex and morbidity.
Results: The AD prevalence was 4.07% in 2020 (4.12% women, 3.42% men). During this period 9.91% of people with AD were prescribed SGCs compared with 5.54% in people without AD (P < 0.01). Prescribing of SGCs was significantly higher in women (10.20% vs. 9.42% in men, P < 0.01) and in the elderly. AD and SGC prevalence varied regionally. In a 3-year follow-up period, 58% of people with AD receiving a SGC were prescribed SGCs in > one quarter and 15% in > six quarters. The odds of developing osteoporosis [odds ratio (OR) 3.90 -(definition 1) and 1.80 (definition 2)] and diabetes [OR 1.90 (definition 1) and 1.38 (definition 2)] were significantly higher in people with AD on SGCs, especially in the frequently prescribed group compared with the rarely prescribed group, regardless of quantified use.
Conclusions: A considerable number of people with AD in Germany are prescribed long-term SGCs. The onset of medical conditions known to be harmful effects of steroids was significantly more frequent in those who were frequently prescribed SGCs, indicating the need for optimized healthcare.
Atopic dermatitis (AD) is a condition that causes severe itching and dry skin. AD is common and affects almost 100 000 people in Germany. The treatment for AD with systemic glucocorticosteroids (SGCs) should be limited to short-term use, typically lasting up to 3 weeks during periods of acute flares. This study aimed to investigate how often and for how long people with AD in Germany use SGCs and whether there are any adverse effects associated with their use, using data from health insurance claims. We found that a significant number of people with AD were frequently prescribed SGCs for prolonged periods of time, which could increase the risk of side-effects such as osteoporosis, diabetes, gastritis, depression and oesophageal reflux. Overall, our study findings highlight the importance of reducing the overuse of SGCs and advocate the use of approved long-term medications for people with AD, to reduce the risks of harmful side-effects.
© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.