Long-term oral prednisolone exposure in primary care for bullous pemphigoid: population-based study

Persson, Monica S.M.; Harman, Karen E.; Thomas, Kim S.; Chalmers, Joanne R.; Vinogradova, Yana; Langan, Sinead M.; Hippisley-Cox, Julia; Gran, Sonia

Abstract

Background: Oral prednisolone is the mainstay treatment for bullous pemphigoid, an autoimmune blistering skin disorder affecting older people. Treatment with moderate-to-high doses is often initiated in secondary care, but then continued in primary care.
Aim To describe long-term oral prednisolone prescribing in UK primary care for adults with bullous pemphigoid from 1998 to 2017.
Design and setting: A prospective cohort study using routinely collected data from the Clinical Practice Research Datalink, a primary care database containing the healthcare records for over 17 million people in the UK.
Method: Oral prednisolone exposure was characterised in terms of the proportion of individuals with incident bullous pemphigoid prescribed oral prednisolone following their diagnosis, and the duration and dose of prednisolone.
Results: In total, 2312 (69.6%) of 3322 people with bullous pemphigoid were prescribed oral prednisolone in primary care. The median duration of exposure was 10.6 months (interquartile range [IQR] 3.4–24.0). Of prednisolone users, 71.5% were continuously exposed for >3 months, 39.7% for >1 year, 14.7% for >3 years, 5.0% for >5 years, and 1.7% for >10 years. The median cumulative dose was 2974 mg (IQR 1059–6456). Maximum daily doses were ≥10 mg/day in 74.4% of prednisolone users, ≥20 mg/day in 40.7%, ≥30 mg/day in 18.2%, ≥40 mg/day in 6.6%, ≥50 mg/day in 3.8%, and ≥60 mg/day in 1.9%.
Conclusion: A high proportion of people with incident bullous pemphigoid are treated with oral prednisolone in UK primary care. Action is required by primary and second care services to encourage use of steroid-sparing alternatives and, where switching is not possible, ensure prophylactic treatments and proactive monitoring of potential side effects are in place.

Citation

Persson, M. S., Harman, K. E., Thomas, K. S., Chalmers, J. R., Vinogradova, Y., Langan, S. M., Hippisley-Cox, J., & Gran, S. (2021). Long-term oral prednisolone exposure in primary care for bullous pemphigoid: population-based study. British Journal of General Practice, 71(713), e904-e911. https://doi.org/10.3399/BJGP.2020.0870

• Journal Article Type: Article
• Acceptance Date: May 17, 2021
• Online Publication Date: Oct 4, 2021
• Publication Date: 2021-12
• Deposit Date: May 24, 2021
• Publicly Available Date: Oct 4, 2021
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Electronic ISSN: 1478-5242
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 71
• Issue: 713
• Pages: e904-e911
• DOI: https://doi.org/10.3399/BJGP.2020.0870
• Keywords: Bullous pemphigoid; Clinical Practice Research Datalink; corticosteroid; prednisolone; prescriptions; primary health care
• Public URL: https://nottingham-repository.worktribe.com/output/5569542
• Publisher URL: https://bjgp.org/content/71/713/e904
• Additional Information: Abstract published in Special Issue: Abstracts for the British Association of Dermatologists 101st Annual Meeting, Virtual Meeting.; P76: Long-term oral prednisolone exposure in primary care for bullous pemphigoid: a population-based study. Br J Dermatol, 185: 62-62. https://doi.org/10.1111/bjd.20041