Duration-Dependent Adverse Events of Systemic Glucocorticosteroids in Atopic Dermatitis: A Nationwide Claims Cohort...

Systemic glucocorticosteroids (SGCs) are recommended only for short-term treatment of atopic dermatitis (AD) because of their side effect profile. Nevertheless, prolonged and repeated use remains common in routine care. Evidence on whether treatment duration or cumulative dose is the main driver of adverse events is limited. Therefore, the aim of this study is to investigate the longitudinal association between SGC treatment duration and side effects in persons with AD and to compare its impact with cumulative dose.

This was a retrospective cohort study based on German statutory health insurance data that included persons with AD initiating SGC therapy. Associations between SGC exposure and side effect were analyzed using logistic regression and adjusted time-dependent Cox models.

Longer treatment duration was associated with higher odds of multiple side effects, including osteoporosis (odds ratio [OR] 1.21-1.27). In time-dependent Cox models, each additional quarter of SGC therapy increased the hazard of mental disorders (hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.10-1.32), gastritis/duodenitis (HR 1.07; 1.00-1.15), osteoporosis (HR 1.37; 1.23-1.52), hypertension (HR 1.26; 1.08-1.48), and diabetes mellitus (HR 1.35; 1.09-1.69).

Prolonged SGC therapy is associated with increasing risks of multiple side effects, supporting guideline recommendations for short-term use only. Documented SGC treatment duration showed more consistent associations with side effects than cumulative dose.