Between Guidelines and Daily Practice: The Persistent Use of Parenteral Depot Corticosteroids in Germany

Parenteral depot corticosteroids (PDCs) continue to be prescribed for allergic and respiratory diseases, despite clear guideline recommendations against their use. This clinical practice raises significant safety concerns. We analyzed current PDC use in Germany and characterized prescribing patterns.

Retrospective analysis of anonymized, longitudinal prescription data (IQVIA LRx) and evaluation of anonymized electronic medical record (EMR) data (IQVIA Disease Analyzer) from October 2023 to September 2024. Data were stratified by diagnosis, prescription frequency, prescriber specialty, region, age group and comorbidities.

The analysis of prescription data revealed that 9984 asthma and 5279 chronic obstructive pulmonary disease (COPD) patients received at least one PDC injection annually by general practitioners, which are the predominant prescribers. Of these patients, the majority received a single prescription. Regional differences were observed with particularly high prescription rates in western regions such as Rhineland-Palatinate and Saarland. Monthly PDC prescription rates follow seasonal patterns of most common pollen allergens. Furthermore, over 23,000 patients with rhinopathy but without asthma or COPD received at least one prescription as well as approximately 3700 patients with chronic sinusitis with or without nasal polyps but no asthma or COPD.

PDCs continue to be administered to a relevant number of patients with asthma, COPD, and upper airway diseases despite clear guideline recommendations against systemic steroid treatment. The injection frequency, as well as the association with allergic comorbidities and seasonal patterns are compatible with the treatment of seasonal allergies. This underscores the need for targeted educational initiatives and stronger implementation of guideline-adherent therapies.