Cardiovascular and thrombosis risks of prolonged vs. short-term use of oral corticosteroids among atopic dermatitis patients in the United States.

Summary: Background: Despite guidelines discouraging their use, oral corticosteroids (CS) remain commonly prescribed for managing moderate-to-severe atopic dermatitis (AD). Given limited safety data on oral CS in AD, we evaluated the risks of major adverse cardiovascular events (MACE), and venous thromboembolism (VTE) associated with prolonged vs short-term use, within a cohort from a commercially insured U.S. population. Type of Study: Population-based cohort study: Methods: Using the U.S. Optum CDM database (03/2017–03/2024), we included AD patients aged ≥12 years who initiated oral CS. We emulated a hypothetical “per-protocol” target trial using a clone-censor-weight approach to compare the risks of VTE (deep vein thrombosis, pulmonary embolism) and MACE (non-fatal MI, non-fatal stroke, and all-cause death) with prolonged (>30 days) vs short-term (≤30 days) oral CS use at 2 years. Results: Among 52,688 AD patients who initiated oral CS (average age 53; 62% female), crude incidence rates (IR) were higher for prolonged users, with IRs of 2.62 (95% CI, 2.40–2.84) per 100 person-years for MACE and 0.43 (95% CI, 0.35–0.53) per 100 person-years for VTE, compared to short-term users, with IRs of 1.61 (95% CI, 1.50–1.74) per 100 person-years for MACE and 0.16 (95% CI, 0.12–0.20) per 100 person-years for VTE. Adjusted analyses showed a 2-year risk increase for prolonged vs short-term use of 1.24 (95% CI, 1.1–1.4) for MACE and 1.81 (95% CI, 1.3–2.5) for VTE. Conclusion: In patients with AD, prolonged oral CS use >30 days showed an increased risk of MACE and VTE compared to short-term use ≤30 days. Mark Lebwohl¹, Christopher G. Bunick², Ruth Ann Vleugels³, Ayman Grada⁴, Emma Xiaomeng Yue⁴, Lani R Wegrzyn⁴, Elvira D’Andrea⁴ 1. Department of Dermatology, Icahn School of Medicine at Mt. Sinai Hospital, New York, NY, United States. 2. Yale School of Medicine Department of Dermatology, New Haven, CT, United States. 3. Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. 4. AbbVie, Inc., North Chicago, IL, United States. Clinical Research: Epidemiology and Observational Research