Systemic Corticosteroid Dispensing Patterns Among Patients with Sinonasal Polyps: A Population-Based Retrospective Cohort Study.
Systemic 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.
This study investigates dispensing patterns of SCS among CRSwNP patients.
A population-based retrospective cohort study of community-based pharmacy claims data. The study period was between January 1, 2012 and December 31, 2022.
The province of British Columbia, Canada, home of approximately 5 million residents.
Insured residents diagnosed with CRSwNP and at least 2 years of data on dispenses.
SCS dispenses were identified for all cohort members.
Cumulative SCS doses were calculated. Dispensed SCS courses were characterized based on administration method, dose, course length, and prescriber specialties. Prednisone prescribing patterns were evaluated.
A 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.
Population-based dispensing data showed unwarranted variation in SCS dispensing among CRSwNP patients, which may contribute to differential exposure to SCS-related adverse outcomes.
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.
This study investigates dispensing patterns of SCS among CRSwNP patients.
A population-based retrospective cohort study of community-based pharmacy claims data. The study period was between January 1, 2012 and December 31, 2022.
The province of British Columbia, Canada, home of approximately 5 million residents.
Insured residents diagnosed with CRSwNP and at least 2 years of data on dispenses.
SCS dispenses were identified for all cohort members.
Cumulative SCS doses were calculated. Dispensed SCS courses were characterized based on administration method, dose, course length, and prescriber specialties. Prednisone prescribing patterns were evaluated.
A 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.
Population-based dispensing data showed unwarranted variation in SCS dispensing among CRSwNP patients, which may contribute to differential exposure to SCS-related adverse outcomes.
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.
Authors
Valle Soto Valle Soto, Manges Manges, Gadermann Gadermann, Thamboo Thamboo, Sutherland Sutherland
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