(320) Association Between Oral Corticosteroid Prescribing Patterns and Appropriate Fracture Preventive Care in People with Atopic Eczema in the UK

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 994

Presenting Author(s)

Julian Matthewman
– Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, Greater London, United Kingdom

Co-Author(s)

Mina Tadrous, PharmD, PhD, MS
– Assistant Professor, University of Toronto, Toronto, Ontario, Canada
Kathryn Mansfield
– London School of Hygiene & Tropical Medicine, London, England, United Kingdom
Deva Thiruchelvam
– Women's College Hospital, Toronto, Ontario, Canada, Canada
Donald Redelmeier
– Women's College Hospital, Toronto, Ontario, Canada, Canada
Angela M. Cheung, MD, PhD, FRCPC
– Senior Physician-Scientist, University Health Network, Toronto, Ontario, Canada, Toronto, ON, Canada
Iliana Lega
– Women's College Hospital, Toronto, Ontario, Canada, ON, Canada
Daniel Prieto-Alhambra, MD, MSc, PhD, FISPE
– Professor of Pharmaco- and Device Epidemiology, CSM, NDORMS, University of Oxford, University of Oxford, Oxford, United Kingdom
Lawrence Cunliffe
– Women's College Hospital, Toronto, Ontario, Canada, Canada
Sinéad Langan
– London School of Hygiene & Tropical Medicine, United Kingdom
Aaron M. Drucker, MD, ScM
– Women’s College Research Institute, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada, Canada

Background: Atopic eczema is commonly treated with oral corticosteroids (OCS), which increase fracture risk. Fracture-preventive medications, including bisphosphonates, are recommended to counter the negative effects of OCS on bone health when individuals are prescribed >=450mg prednisolone equivalent dose in 6 months. People with atopic eczema are prescribed OCS in different patterns (e.g., continuously or intermittently) which may affect how fracture preventive care is prescribed.

Objectives: To determine if people receiving intermittent OCSs are less likely to receive adequate fracture-preventive care than people receiving the same cumulative OCS dose continuously and, if so, if this affects fracture risk in these people.

Methods: We conducted a nationwide cohort study using routinely collected UK general practice data (January 1998 to January 2020). We identified 20,680 individuals aged 66+ with atopic eczema who had received at least 450mg prednisolone equivalent dose in 6 months. Of these, 13,240 were intermittent and 7,440 were continuous OCS users. We estimated hazard ratios from Cox regression for the outcome of fracture preventive care (prescriptions for bisphosphonates, calcium, vitamin D), and secondary outcome of major osteoporotic fractures, comparing those with continuous OCS use to the rate of those with intermittent OCS use.

Results: People prescribed continuous OCSs had higher rates of fracture preventive care than those prescribed OCSs intermittently (age, sex, deprivation and comorbidity adjusted HR 5.11; 95%CI 4.63-5.63). Effect estimates were attenuated in sensitivity analyses using different continuous/intermittent OCS definitions, however a strong positive association between continuous use and fracture preventive care prescribing remained. Those prescribed OCS continuously were at higher risk of major osteoporotic fractures (adjusted HR 1.46; 95%CI 1.18-1.82). Results were similar when we replicated analyses in a population-based cohort from Ontario, Canada.

Conclusions: There may be missed opportunities for appropriate fracture preventative care in people with atopic eczema prescribed intermittent OCSs, suggesting a need for updated treatment guidelines. Future implementation research could explore potential solutions such as electronic medical record reminders for individuals receiving threshold cumulative OCS prescriptions.