Systemic Corticosteroid and Tendino-Myopathy Risk in Pediatric Asthma: A Self-Controlled Case Series

Although systemic corticosteroids are widely used for asthma, their potential association with tendino-myopathy has not been well established.

We aimed to evaluate whether systemic corticosteroid use is associated with risk of tendino-myopathy in children with asthma.

This self-controlled case series study used nationwide health insurance claims data from South Korea between 2006 and 2020. Among children and adolescents aged 6 to 18 years with newly diagnosed asthma, individuals with at least one tendino-myopathy and a history of systemic corticosteroid use during the 1-year observation period were included. Conditional Poisson regression models were used to estimate incidence rate ratios (IRRs) for the occurrence of tendino-myopathy during exposure periods compared with non-exposure periods.

Among 398,748 subjects aged 6-18 years during the study period, 41,124 with newly diagnosed asthma were identified. Among these, 5,060 who experienced at least one tendino-myopathy and were exposed to systemic corticosteroids were included in the final analysis. The incidence of tendino-myopathy was significantly higher during the exposure periods of systemic corticosteroids compared with non-exposure periods (IRR, 2.68; 95% CI, 2.44-2.94). The risk remained elevated during both 1-7 days (IRR, 1.60; 95% CI, 1.49-1.73) and 8-14 days after discontinuation (IRR, 1.15; 95% CI, 1.05-1.26).

Systemic corticosteroid use was significantly associated with an increased risk of tendino-myopathy, which persisted for up to 14 days after discontinuation. These findings suggest the need for careful monitoring of musculoskeletal adverse events during the early period following systemic corticosteroid therapy in pediatric asthma.