ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P1011 | DOI: 10.1530/endoabs.63.P1011

The prevalence of oral glucocorticoid use in doses associated with risk of tertiary adrenal insufficiency

Margret J Einarsdottir, Penelope Trimpou, Daniel S Olsson, Gudmundur Johannsson & Oskar Ragnarsson

Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Objective: Patients who receive ≥5 mg prednisolone per day, for more than 2–3 weeks, are at risk of developing glucocorticoid (GC) induced adrenal insufficiency (tertiary adrenal insufficiency, 3° AI). The aim of this study was to a) determine the prevalence of GC use in doses that are associated with development of 3° AI, b) assess prescription pattern of short and long-term GC treatment in adults and children, and c) investigate the indication for the GC treatment.

Methods: This was a retrospective cohort study where dispensed GC prescriptions were obtained from the Swedish Prescribed Drug Register. Individuals who had received a prescription of ≥5 mg prednisolone (or equivalent dose of other GC) daily, for more than 21 days, from 1 January 2007 to 31 December 2014, were included. Information on underlying diseases was obtained from the Swedish National Patient Register and the Västra Götaland’s regional healthcare database. The patients were divided into four groups according to the length of the GC treatment: 1. Single-occasion users (one prescription). 2. Occasional users (> 1 prescription but < 300 tablets/year). 3. Medium-term users (> 300 tablets/year for 0-2 years in a row) and 4. Long-term users (> 300 tablets/year for > 2 years in a row).

Results: Of 1,585,335 inhabitants in the region of Västra Götaland, 223,211 had received a prescription of oral GCs (women 55.6%). The mean age was 48.4±24.2 (range 0.1–107) years. A total of 118,456 (53.1%) were single-occasion users, 69,036 (30.9%) were occasional users, 27,831 (12.5%) were medium-term users and 7,888 (3.5%) were long-term users. The overall prevalence of oral GC use was 14.1%; 7.5% for single-occasion users, 4.4% for occasional users, 1.8% for medium-term users and 0.5% for long-term users. The highest prevalence rate (27.4%) was found in men aged 80–89 years, and lowest (7.5%) in men 10–19 years of age. Prevalence in children 0–9 years was 10.6%. The most frequently used GCs were betamethasone (53.8%) and prednisolone (45.3%). COPD and asthma were the most common indications for treatment (17.2%), followed by allergy (12.5%), neoplasms (11.5%) and skin disorders (10.1%). Allergy was the most frequent indication in children and adolescents (0–19 years).

Conclusion: Between the years 2007 and 2014, every seventh individual received treatment with oral GC in doses that are associated with a risk of developing 3° AI. The highest prevalence was seen in the elderly where every forth individual received GC treatment.

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