Inhaled corticosteroids for COVID-19: a real-world data analysis on guideline adherence

Area of Science:

• Pharmacology
• Public Health
• General Practice

Background:

• A Dutch medical guideline update on November 2, 2021, recommended considering inhaled corticosteroids (ICSs) for vulnerable COVID-19 patients.
• This recommendation was adopted internationally during the pandemic.

Purpose of the Study:

• To assess General Practitioners' (GPs) adherence to the updated COVID-19 guideline regarding ICS prescriptions.
• To determine if real-world data quality is adequate for analyzing guideline impact on prescribing behavior.

Main Methods:

• Retrospective cohort study utilizing Dutch primary care data (Extramural Leiden University Medical Center Academic Network database).
• Involved 129 general practices in the Leiden-The Hague area.
• Interrupted time series analysis was employed to evaluate the guideline's effect on ICS prescription rates, controlling for trends and seasonality.

Main Results:

• 131,482 patients with 164,098 COVID-19 consultations were analyzed between July 1, 2020, and August 1, 2022.
• Following the guideline update, a significant decrease in overall ICS prescription rate was observed (IRR 0.47).
• Prescription rates for vulnerable patients remained unchanged (IRR 0.93), while less vulnerable patients showed a significant decrease (IRR 0.29).

Conclusions:

• The guideline revision significantly influenced GP prescribing behavior for COVID-19 patients.
• ICS prescription rates remained stable for vulnerable individuals but decreased notably for less vulnerable patients.
• Electronic health records are suitable for evaluating guideline adherence changes using interrupted time series analysis.