Fifteen-year nationwide trends in systemic glucocorticoid drug use in Denmark

in European Journal of Endocrinology
Correspondence should be addressed to K Laugesen; Email: Kristina.laugesen@clin.au.dk
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Objective

Glucocorticoid treatment of inflammatory disorders is associated with significant adverse effects related to glucocorticoid excess as well as adrenal insufficiency. This necessitates awareness of its use. We therefore investigated trends in systemic glucocorticoid use as well as morbidity and comedications among users.

Design

Cross-sectional drug utilisation study.

Methods

We conducted a population-based study of 926,314 users of systemic glucocorticoids (oral and injectable formulations) from 1999 to 2014 using Danish nationwide registries. We computed annual prevalence and incidence of systemic glucocorticoid use and prevalence of comedications and morbidity. Further, we assessed the annual amount of disease-modifying drug use.

Results

Of the 926,314 users of systemic glucocorticoids, 54% were female and median age at first-time use was 55 years. The annual prevalence was ≈ 3%, while the incidence was ≈ 1.4/100 person years (p-y). Both figures remained constant from 1999 to 2014. In the elderly, the annual prevalence was 6.7–7.7% (60–79 years of age) and 9.7–11% (≥80 years of age). Incidence increased among persons aged ≥80 years from 3.0/100 p-y in 1999 to 3.6/100 p-y in 2014. Concomitantly, the annual amount of for example methotrexate, azathioprine and tumour necrosis factor (TNF)-alpha agents increased and new biological agents emerged. The most frequent comedications were antibiotics (49%), cardiovascular drugs (38%) and NSAIDs (37%).

Conclusions

Our findings confirm a widespread use of systemic glucocorticoids, especially in the elderly, which prevails despite increased use of disease-modifying drugs. The continuously prevalent use of glucocorticoid use constitutes a challenge for the endocrine community.

Downloadable materials

  • Supplementary Table 1. Anatomical Therapeutic Chemical classification system of the World Health Organization (ATC codes) for systemic glucocorticoids.
  • Supplementary Table 2. Comedications. Anatomical Therapeutic Chemical classification system of the World Health Organization (ATC codes) and Nordic Medico-Statistical Committee’s Classification of Surgical Procedures (NCSP).
  • Supplementary Table 3. Morbidity. Eighth Revision of the International Classification of Diseases (ICD-8) until 1994 and the Tenth Revision (IDC-10) codes.

 

     European Society of Endocrinology

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    Prevalence (%) and incidence (per 100 person years) of systemic glucocorticoid use, Denmark 1999–2014. (A) Prevalence (%) in the overall population and stratified by sex, (B) prevalence stratified by age group, (C) incidence (per 100 person years) in the overall population and stratified by sex and (D) incidence (per 100 person years) stratified by age group.

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    Amount of annual disease-modifying drugs use expressed in defined daily dose (DDD), Denmark 1999–2014. (A) Conventional disease-modifying drugs. (B) Tumour necrosis factor (TNF)-alpha agents. (C) Other biological agents. Methotrexate and rituximab are not expressed in DDD but grams (active substance). Use of methotrexate increased from 2007 g in 1999 to 6225 g in 2014. Use of rituximab increases from 1000 g in 2004 to 10,000 g in 2014.

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    Frequency of comedication use assessed ≤1 year before initial use of a systemic glucocorticoid.

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    Frequency of morbidity assessed any time before initial use of a systemic glucocorticoid. COPD, chronic pulmonary disease. PAD, peripheral artery disease; PMR/GCA, polymyalgia rheumatica/giant cell arthritis; RA, rheumatoid arthritis.

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