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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

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


Authors

Monica S.M. Persson

Karen E. Harman

Joanne R. Chalmers

Sinead M. Langan

Julia Hippisley-Cox

SONIA GRAN SONIA.GRAN@NOTTINGHAM.AC.UK
Associate Professor



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., …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 Mar 29, 2024
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

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