High Mortality Rate in Oral Glucocorticoid Users: A Population-Based Matched Cohort Study

Area of Science:

• Pharmacology
• Epidemiology
• Clinical Medicine

Background:

• Oral glucocorticoids (GCs) are widely prescribed for inflammatory and autoimmune conditions.
• Long-term use of GCs is associated with various adverse effects.
• Understanding the impact of GCs on mortality is crucial for patient management.

Purpose of the Study:

• To investigate all-cause and disease-specific mortality in a large population-based cohort of oral GC users.
• To compare mortality rates between different doses of oral GCs and matched controls.
• To identify specific causes of death associated with oral GC use.

Main Methods:

• Retrospective, matched cohort study using Swedish prescription and death registries.
• Included patients receiving prednisolone ≥5 mg/day (or equivalent) for ≥21 days.
• Categorized users into non-users, low-dose (<0.5 DDD/day), medium-dose (0.5-1.5 DDD/day), and high-dose (>1.5 DDD/day) groups.
• Utilized time-dependent Cox proportional hazard models for adjusted hazard ratios (HRs).

Main Results:

• Oral GC users exhibited significantly higher all-cause mortality (adjusted HR 2.08) compared to controls.
• Adjusted HRs for all-cause mortality increased with GC dose: 1.31 (non-users), 3.64 (low-dose), 5.43 (medium-dose), and 5.12 (high-dose).
• High-dose users showed the highest adjusted HRs for sepsis (6.71) and pulmonary embolism (7.83).

Conclusions:

• Oral GC use is associated with increased mortality, independent of comorbidities.
• Higher doses of oral GCs are linked to a greater risk of death, particularly from sepsis and pulmonary embolism.
• Further research is needed to establish the causal relationship between GC exposure and excess mortality.