(AI) Risk of Hospitalization for Vaso-Occlusive Episode in Patients with Sickle-Cell Disease After Out-Patient Exposure to Systemic Corticosteroids

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1033

Presenting Author(s)

Margaux Lafaurie
– Service de Pharmacologie M�dicale et Clinique, Centre Hospitalier Universitaire de Toulouse, France, Toulouse, Haute-Garonne, France

Co-Author(s)

Ondine Walter
– CIC1436, Team PEPPS, Toulouse University Hospital, France, France
Pierre Cougoul
– Deparment of Internal Medicine, Toulouse University Hospital, France, France
Julien Maquet
– CIC1436, Team PEPPS, Toulouse University Hospital, France, France
Pablo Bartolucci
– Department of Internal Medicine, Reference center of sickle cell disease, Mondor University Hospital, Créteil, France, France
Maryse Lapeyre-Mestre
– CIC 1436, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, France, France
Guillaume Moulis
– CIC1436, Team PEPPS, Toulouse University Hospital, France, France

Background: Sickle cell disease (SCD) is an inherited disorder (500 newborns per year in France). Vaso-occlusive episodes (VOEs) cause an important morbi-mortality. Exposure to systemic corticosteroids has been suspected to increase the occurrence of VOEs in case reports or series. No comparative study has been conducted.

Objectives: We aimed to assess the risk of hospitalization for VOE associated with out-hospital exposure to systemic corticosteroids in patients with SCD in France.

Methods: Data source was the French national health database. The study population consisted in all patients with SCD with at least one hospitalization for VOE between 2010 and 2018, identified with a primary discharge diagnosis of VOE (D57.0 code of the international classification of disease,10th version; positive predictive value: 98.6%). All SCD genotypes were included. Patients hospitalized during the three months before the first VOE were excluded. We performed a case-case-time-control study which allows a self-adjustment for time-independent confounders. The outcome was the first hospitalization for VOE. The exposure to oral and injectable corticosteroids, identified using out-hospital
reimbursement data, was assessed during a case period (28 days before the outcome) compared to the exposure during a control period (28 days, starting 84 days before the outcome). The same comparison was made among future cases (matched patients hospitalized for VOE the year after the given case), in order to adjust for the trend of exposure to corticosteroids (calendar variations).

Results: Overall, 5,151 patients were included in the main analysis. Corticosteroid exposure was significantly associated with the occurrence of hospitalizations for VOEs: adjusted Odds Ratio (aOR): 3.8 (95% Confidence Interval - CI: 2.4-5.6). In patients exposed to hydroxyurea, the aOR was 2.6 (95% CI: 1.1-6.4); it was 4.0 (95% CI: 2.5-6.3) in unexposed patients. These results were consistent in children and adults.

Conclusions: In conclusion, systemic corticosteroids were
associated to an increased risk of hospitalization for VOEs and should be limited in patients with SCD.