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Systemic Corticosteroid Dispensing Patterns Among Patients with Sinonasal Polyps: A Population-Based Retrospective
Laura Valle Soto1, Amee Manges2, Anne Gadermann2
1Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.
Summary
Systemic corticosteroids (SCS) prescribing for chronic rhinosinusitis with nasal polyps (CRSwNP) shows significant variation. This may lead to unequal exposure to SCS-related adverse outcomes, highlighting the need for standardized treatment guidelines.
Area of Science:
- Otolaryngology
- Pharmacology
- Public Health
Background:
- Systemic corticosteroids (SCS) are frequently used for chronic rhinosinusitis with nasal polyps (CRSwNP).
- Current guidelines for SCS use in CRSwNP are not standardized.
- Evidence suggests a dose-response relationship between SCS and adverse outcomes, even at low cumulative doses.
Purpose of the Study:
- To investigate SCS dispensing patterns in CRSwNP patients.
- To identify factors associated with high cumulative SCS exposure.
- To evaluate prescribing practices for SCS in CRSwNP.
Main Methods:
- Population-based retrospective cohort study using pharmacy claims data from British Columbia, Canada (2012-2022).
- Included 7000 CRSwNP patients with at least two years of dispensing data.
- Analyzed cumulative SCS doses, course characteristics, and prescriber specialties.
Main Results:
- 21.8% of CRSwNP patients received ≥1 gram of SCS, a threshold linked to adverse outcomes.
- Higher SCS exposure was observed in rural populations and those with comorbid respiratory conditions.
- General practitioners were the most frequent prescribers; otolaryngologists showed inconsistent prednisone prescribing.
Conclusions:
- Unwarranted variation in SCS dispensing for CRSwNP exists, potentially leading to differential adverse outcome exposure.
- Standardized clinical guidelines are necessary to optimize SCS use, treatment, and patient safety in CRSwNP management.
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