SCS Use May Predispose Patients Who Have CRSwNP to Worse Health Outcomes

Alternative treatment strategies that do not incorporate use of systemic corticosteroids (SCS) to treat chronic rhinosinusitis with nasal polyps (CRSwNP) may enable patients avoid high health care costs and adverse clinical outcomes, determined the authors of a new study published in Clinical Therapeutics.

The study period was January 2003 to June 2019, with health care claims data gleaned from the IBM MarketScan Databases to identify adult patients living with CRSwNP, with the index date being that of the first SCS prescription and enrollment for at least 1 year before (pre-index) and after that date (post index) required. Outcomes were compared between 2 groups of patients with CRSwNP: users (n = 37,740) and nonusers of SCS (control group; n = 7032).

Beyond adverse outcomes and health care costs, outcomes were compared for having 1 to 3 and 4 or more SCS prescriptions, having or not having a history of NP surgery, and the presence or not of comorbid asthma. NP had to be diagnosed between January 1, 2003, and June 30, 2018.

“There is no published literature to date on utilization patterns and subsequent adverse outcomes of SCS use among patients with CRSwNP, yet there are multiple studies among patients with asthma,” the authors wrote. “The present study filled this gap by using data from administrative health care claims to assess specific SCS-related adverse outcomes, health care resource utilization (HRU), and health care costs among patients with CRSwNP in the United States.”

A 10% overall greater risk for an adverse outcomes was evident among the group with a history of SCS use compared with the control patients (incidence rate ratio [IRR], 1.10; 95% CI, 1.05-1.16). When looking at individuals conditions, higher risks were seen for these conditions among SCS users vs nonusers: pneumonia, 91% (IRR, 1.92; 95% CI, 1.50-2.44); obesity, 45% (IRR, 1.45; 95% CI, 1.31-1.61); sleep apnea, 27% (IRR, 1.27; 1.11-1.47); anxiety/depression, 24% (IRR, 1.24; 95% CI, 1.12-1.37); fracture, 23% (IRR, 1.23; 95% CI, 1.07-1.40); and hypertension, 10% (IRR, 1.10; 95% CI, 1.01-1.20).

Approximately 24% of patients had 4 or more SCS prescriptions, and 76.5% had 1 to 3 prescriptions. There was also at least 1 claim for NP surgery among 52.3% of the patients with SCS use history and 27.8% of the control participants, and comorbid asthma was seen in close to twice as many SCS users as controls: 33.0% vs 17.4%.

In addition, there were higher risks seen from SCS use among the following patient groups:

• 30% higher risk seen among individuals with 4 or more SCS prescription claims but not NP surgery (n = 2993) compared with controls with no surgical history (n = 5078) (IRR, 1.30; 95% CI, 1.18-1.44).
• 36% higher risk seen among individuals with 4 or more SCS prescription claims and history of comorbid asthma (n = 4195) vs controls with asthma (n = 1226) (IRR, 1.36; 95% CI, 1.19-1.55)
• 60% higher total all-cause costs SCS uses compared with nonusers (P < .001)

Study analyses also show that patients with 1 to 3 SCS prescriptions had cumulative and mean daily doses of SCS that were 2.7-fold lower vs those with 4 or more prescriptions: 401 vs 1087 mg and 1.1 vs 3.0 mg/d. Also, fewer patients who had NP surgery needed at least 1 SCS prescription vs SCS users who did not have surgery, at 26.4% vs 43.2%.

Regarding HRU per patient per year, there were significantly more outpatient surgeries, emergency department (ED) visits, outpatient pharmacy prescriptions, CRSwNP-related inpatients admissions, CRSwNP-related ED visits, CRSwNP-related outpatient prescriptions, NP surgeries, and revisions to and repeated NP surgeries seen among those with SCS use vs no SCS use. Total all-cause health-care costs were also higher among SCS users.

“In this population of patients with CRSwNP, SCS use was associated with increased incidence of several adverse outcomes and increased health care costs,” the authors determined. “These findings are consistent with those from previous studies.”

They also highlight that their findings are the first to demonstrate an adverse outcomes gap between SCS users and controls who undergo NP surgery vs controls who do not have surgery.

“These findings highlight the need for alternative treatment strategies in patients with CRSwNP that either avoid SCS use or limit SCS frequency, including in the new era of biologics,” they concluded. “Approaches to CRSwNP treatment that rely less on SCSs may reduce the risk for associated adverse outcomes and decrease HRU and costs.”

Reference

Davis GE, Zeiger RS, Emmanuel B, et al. Systemic corticosteroid–related adverse outcomes and health care resource utilization and costs among patients with chronic rhinosinusitis with nasal polyposis. Clin Ther. Published online August 31, 2022. doi:10.1016/j.clinthera.2022.08.004