Longitudinal evaluation of adverse events due to steroid use in primary immune thrombocytopenia: A population‐based study

• Published in: British journal of haematology Vol. 204; no. 5; pp. 1986 - 1993
• Main Authors: Wang, Jiaan‐Der, Ku, Fan‐Chen, Chiang, I‐Ju, Ku, Meng‐Yun, Chen, Yi‐Ming, Chien, Li‐Nien
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2024
• Subjects: Adolescent; Adult; adverse events; Aged; Databases, Factual; Female; Humans; Idiopathic thrombocytopenic purpura; immune thrombocytopenia; Longitudinal Studies; Male; Middle Aged; Population studies; Prednisolone; Purpura, Thrombocytopenic, Idiopathic - drug therapy; Purpura, Thrombocytopenic, Idiopathic - epidemiology; steroid; Steroid hormones; Steroids; Steroids - administration & dosage; Steroids - adverse effects; Steroids - therapeutic use; Taiwan - epidemiology; Thrombocytopenia; Young Adult; Taiwan; immune thrombocytopenia; adverse events; steroid
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.19358

Summary This study aimed to investigate the association between the steroid use patterns and the risk of AEs in patients with primary immune thrombocytopenia (ITP). A total of 2691 newly diagnosed adults with ITP between 2011 and 2018 were identified from the National Health Insurance Research Database in Taiwan, and the date of first steroid use was defined as the index date. Post‐index steroid use was calculated on a 90‐day basis as a time‐dependent variable and categorized by the average prednisolone‐equivalent daily dose (<10 mg vs. ≥10 mg) and intensity (medication possession ratio <80% vs. ≥80%). Patients were followed up for 1 year from the index date for acute AE events, while chronic AEs were assessed until death, or end of 2019. Compared to patients with low‐dose+low‐intensity steroid use, those with high‐dose+high‐intensity steroid use were associated with a higher risk of acute AE (adjusted incident rate ratio [aIRR]: 1.57, 95% confidence interval [CI]: 1.38–1.78, p < 0.01) and chronic AE (aIRR: 1.26, 95% CI: 1.08–1.47, p < 0.01). Metabolic/endocrine and ophthalmologic disorders demonstrated the strongest correlation with a high dose and intensity. The joint effect of steroid dose and intensity was observed in patients with ITP, and the findings suggest that steroids should be used carefully. Two thousand six hundred and ninety‐one newly diagnosed adults with ITP were identified from National Health Insurance Research Database in Taiwan. Post‐index steroid use was calculated on a 90‐day basis as a time‐dependent variable and categorized into four groups by dose and intensity. The joint effect of steroid dose and intensity was observed in patients with ITP, and the findings suggest that steroids should be used carefully.