对哮喘患者口服皮质类固醇激素不良事件和经济影响的一项系统综述
2018/12/17
摘要
背景：口服皮质类固醇（OCSs）通常用于哮喘控制。与口服激素相关的合并症增加患者和医疗服务提供者的疾病负担。大多数口服激素使用和不良事件风险（AEs）的研究都在非哮喘患者中进行。我们试图系统地回顾有关哮喘患者口服激素负担的文献。
方法：我们系统地回顾了文献，包括MEDLINE（1946年－2017年5月），EMBASE（1974年 -2017年5月）和Cochrane图书馆（2005年-2017年5月），以明确因口服激素治疗哮喘而引起不良反应的研究，以及医疗保健利用和经济负担。
结果：我们检索了9,589次引用文献;并纳入了15项研究。与非激素使用者相比，在糖尿病患者中口服激素使用者的不良事件风险明显增高，OR值1.68（95％CI 1.15-2.46），在高血压患者中OR值为1.34（95％CI 1.23-1.46）。与非OCS使用者相比，在大剂量OCS使用者（> 10 mg）中，任何并发症发生的汇总调整OR为3.35（95％CI 2.94-3.82），骨骼和肌肉并发症为2.30（95％CI 2.18- 2.42）。随着OCS剂量的增加，任何并发症的风险也同时增加，与未使用OCS相比，低剂量（<6 mg），中剂量（5-12 mg）和高剂量（> 10 mg）汇总调整OR为2.26（95％CI 1.37-3.72），2.94（95％CI 2.62-3.29）和3.35（95％CI 2.94-3.82）。
结论：使用口服激素治疗哮喘与并发症的风险增加相关。随着口服激素剂量的增加，风险也会增高。
A systematic review of the adverse events and economic impact associated with oral corticosteroids in asthma.
Al Efraij, Khalid; Johnson, Kate M
Abstract
BACKGROUND: Oral corticosteroids (OCSs) are often used to achieve asthma control. OCS-related comorbidities increase the burden of disease for patients and healthcare providers. Most studies characterizing OCS use and risk of adverse events (AEs) are in non-asthma patients. We sought to systematically review the literature on the burden of OCS use among adults with asthma.
METHODS: We systematically reviewed the literature including MEDLINE (1946-May 2017), EMBASE (1974-May 2017), and the Cochrane Library (2005-May 2017) to identify studies that considered AEs due to OCS treatment of adults with asthma, their burden on healthcare utilization, and costs.
RESULTS: We retrieved 9,589 citations; and 15 studies were included. AEs were significantly higher among OCS-users compared with non-OCS users with pooled adjusted odds ratio (OR) 1.68 (95% CI 1.15-2.46) for diabetes mellitus and 1.34 (95% CI 1.23-1.46) for hypertension. Among high dose OCS-users (>10 mg) compared with non-OCS users, the pooled adjusted ORs for development of any complication was 3.35 (95% CI 2.94-3.82), and bone and muscle complications 2.30 (95% CI 2.18-2.42). The risk of any complication increased with higher doses of OCS, with pooled adjusted OR from 2 studies of 2.26 (95% CI 1.37-3.72), 2.94 (95% CI 2.62-3.29) and 3.35 (95% CI 2.94-3.82) for low dose (<6 mg), medium dose (5-12 mg) and high dose (>10 mg) respectively compared with no OCS use.
CONCLUSIONS: The use of OCS in the management of asthma is associated with a higher risk of complications. This risk is higher as the OCS dose increases.
背景：口服皮质类固醇（OCSs）通常用于哮喘控制。与口服激素相关的合并症增加患者和医疗服务提供者的疾病负担。大多数口服激素使用和不良事件风险（AEs）的研究都在非哮喘患者中进行。我们试图系统地回顾有关哮喘患者口服激素负担的文献。
方法：我们系统地回顾了文献，包括MEDLINE（1946年－2017年5月），EMBASE（1974年 -2017年5月）和Cochrane图书馆（2005年-2017年5月），以明确因口服激素治疗哮喘而引起不良反应的研究，以及医疗保健利用和经济负担。
结果：我们检索了9,589次引用文献;并纳入了15项研究。与非激素使用者相比，在糖尿病患者中口服激素使用者的不良事件风险明显增高，OR值1.68（95％CI 1.15-2.46），在高血压患者中OR值为1.34（95％CI 1.23-1.46）。与非OCS使用者相比，在大剂量OCS使用者（> 10 mg）中，任何并发症发生的汇总调整OR为3.35（95％CI 2.94-3.82），骨骼和肌肉并发症为2.30（95％CI 2.18- 2.42）。随着OCS剂量的增加，任何并发症的风险也同时增加，与未使用OCS相比，低剂量（<6 mg），中剂量（5-12 mg）和高剂量（> 10 mg）汇总调整OR为2.26（95％CI 1.37-3.72），2.94（95％CI 2.62-3.29）和3.35（95％CI 2.94-3.82）。
结论：使用口服激素治疗哮喘与并发症的风险增加相关。随着口服激素剂量的增加，风险也会增高。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（The Journal of asthma. 2018-Dec-04）
（The Journal of asthma. 2018-Dec-04）
A systematic review of the adverse events and economic impact associated with oral corticosteroids in asthma.
Al Efraij, Khalid; Johnson, Kate M
Abstract
BACKGROUND: Oral corticosteroids (OCSs) are often used to achieve asthma control. OCS-related comorbidities increase the burden of disease for patients and healthcare providers. Most studies characterizing OCS use and risk of adverse events (AEs) are in non-asthma patients. We sought to systematically review the literature on the burden of OCS use among adults with asthma.
METHODS: We systematically reviewed the literature including MEDLINE (1946-May 2017), EMBASE (1974-May 2017), and the Cochrane Library (2005-May 2017) to identify studies that considered AEs due to OCS treatment of adults with asthma, their burden on healthcare utilization, and costs.
RESULTS: We retrieved 9,589 citations; and 15 studies were included. AEs were significantly higher among OCS-users compared with non-OCS users with pooled adjusted odds ratio (OR) 1.68 (95% CI 1.15-2.46) for diabetes mellitus and 1.34 (95% CI 1.23-1.46) for hypertension. Among high dose OCS-users (>10 mg) compared with non-OCS users, the pooled adjusted ORs for development of any complication was 3.35 (95% CI 2.94-3.82), and bone and muscle complications 2.30 (95% CI 2.18-2.42). The risk of any complication increased with higher doses of OCS, with pooled adjusted OR from 2 studies of 2.26 (95% CI 1.37-3.72), 2.94 (95% CI 2.62-3.29) and 3.35 (95% CI 2.94-3.82) for low dose (<6 mg), medium dose (5-12 mg) and high dose (>10 mg) respectively compared with no OCS use.
CONCLUSIONS: The use of OCS in the management of asthma is associated with a higher risk of complications. This risk is higher as the OCS dose increases.
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