{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T01:16:38Z","timestamp":1793927798480,"version":"4.8.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The use of oral corticosteroids for prolonged periods may be associated with adverse events (AEs). Nevertheless, the risk of AEs with oral corticosteroids, especially among patients with atopic dermatitis (AD), has not been comprehensively investigated and lacks evidence on duration of treatment.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the association between long-term exposure to oral corticosteroids and AEs among adult patients with AD.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This nested case-control study used data from the Health Insurance Review and Assessment Service database of South Korea between January 1, 2012, and October 31, 2021, which included 1 year prior to the cohort entry date of January 1, 2013, for assessing exclusion criteria and baseline characteristics, and 1 year after the study end date of October 31, 2020, to ensure a minimum duration for assessing exposure. Among the population of adults with AD, patients diagnosed with any of 11 AEs were matched with patients who had never received a diagnosis of any of the 11 AEs.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Long-term use of oral corticosteroids was defined as cumulative supply of more than 30 days or more than 90 days of oral corticosteroid prescription per year.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>We used multivariable conditional logistic regression analyses to measure the risk of 11 individual outcomes (osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataract, or glaucoma) as the composite outcome, controlling for potential confounders. We further classified the composite outcome to individual outcomes to evaluate the AE-specific risk.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 1\u202f025\u202f270 patients with AD between 2013 and 2020, 164\u202f809 cases (mean [SD] age, 39.4 [14.8]; 56.9% women) were matched with 328\u202f303 controls (mean [SD] age, 39.3 [14.7]; 56.9% women) for sex, age, cohort entry date, follow-up duration, and severity of AD, where the balance of most baseline characteristics was achieved. A total of 5533 cases (3.4%) and 10\u202f561 controls (3.2%) were exposed to oral corticosteroids for more than 30 days, while 684 cases (0.4%) and 1153 controls (0.4%) were exposed to oral corticosteroids for more than 90 days. Overall, there was no increased risk of AEs with use of oral corticosteroids for more than 30 days (adjusted odds ratio [AOR], 1.00; 95% CI, 0.97-1.04), whereas the risk was slightly higher with use of oral corticosteroids for more than 90 days (AOR, 1.11; 95% CI, 1.01-1.23). The small elevation in experiencing an AE was observed with each cumulative or consecutive year of ever long-term use.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This case-control study found a slightly increased risk of AEs associated with use of oral corticosteroids for more than 90 days per year, which warrants future research to fully elucidate the observed findings.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.23563","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T17:01:30Z","timestamp":1721408490000},"page":"e2423563","source":"Crossref","is-referenced-by-count":41,"title":["Long-Term Use of Oral Corticosteroids and Safety Outcomes for Patients With Atopic Dermatitis"],"prefix":"10.1001","volume":"7","author":[{"given":"Yong Hyun","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Young","family":"Choi","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyesung","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, South Korea"},{"name":"Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieun","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohee","family":"Park","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, South Korea"},{"name":"Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom"},{"name":"School of Pharmacy, Aston University, Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunha","family":"Noh","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, South Korea"},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ja-Young","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Inflammation & Immunology Medical Affairs, Pfizer Pharmaceuticals Korea Ltd, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Young","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Inflammation & Immunology Medical Affairs, Pfizer Pharmaceuticals Korea Ltd, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Young","family":"Shin","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, South Korea"},{"name":"Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea"},{"name":"Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Konkuk University School of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"issue":"1","key":"zoi240746r1","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jid.2016.07.012","article-title":"The burden of atopic dermatitis: summary of a report for the National Eczema Association.","volume":"137","author":"Drucker","year":"2017","journal-title":"J Invest Dermatol"},{"issue":"6","key":"zoi240746r2","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1016\/j.jaad.2022.01.009","article-title":"American Academy of Dermatology guidelines: awareness of comorbidities associated with atopic dermatitis in adults.","volume":"86","author":"Davis","year":"2022","journal-title":"J Am Acad Dermatol"},{"issue":"22","key":"zoi240746r3","doi-asserted-by":"publisher","first-page":"2314","DOI":"10.1056\/NEJMcp042803","article-title":"Clinical practice: atopic dermatitis.","volume":"352","author":"Williams","year":"2005","journal-title":"N Engl J Med"},{"issue":"5","key":"zoi240746r4","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/j.clindermatol.2018.05.007","article-title":"Epidemiology of adult atopic dermatitis.","volume":"36","author":"Sacotte","year":"2018","journal-title":"Clin Dermatol"},{"issue":"6","key":"zoi240746r5","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1111\/all.2018.73.issue-6","article-title":"Epidemiology of atopic dermatitis in adults: results from an international survey.","volume":"73","author":"Barbarot","year":"2018","journal-title":"Allergy"},{"issue":"1","key":"zoi240746r6","doi-asserted-by":"publisher","first-page":"13626","DOI":"10.1038\/s41598-022-17222-y","article-title":"Real-world treatment patterns for atopic dermatitis in South Korea.","volume":"12","author":"Lee","year":"2022","journal-title":"Sci Rep"},{"issue":"1","key":"zoi240746r7","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1203475417733460","article-title":"A treatment algorithm for moderate to severe atopic dermatitis in adults.","volume":"22","author":"Lynde","year":"2018","journal-title":"J Cutan Med Surg"},{"issue":"2","key":"zoi240746r8","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.jaip.2012.09.002","article-title":"Management of difficult-to-treat atopic dermatitis.","volume":"1","author":"Arkwright","year":"2013","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"3","key":"zoi240746r9","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1111\/bjd.15928","article-title":"Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement.","volume":"178","author":"Drucker","year":"2018","journal-title":"Br J Dermatol"},{"issue":"9","key":"zoi240746r10","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1111\/jdv.v36.9","article-title":"European guideline (EuroGuiDerm) on atopic eczema, part I: systemic therapy.","volume":"36","author":"Wollenberg","year":"2022","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"2","key":"zoi240746r11","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1016\/j.jaad.2023.08.102","article-title":"Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies.","volume":"90","author":"Davis","year":"2024","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"zoi240746r12","doi-asserted-by":"publisher","first-page":"497","DOI":"10.5021\/ad.2021.33.6.497","article-title":"Consensus update for systemic treatment of atopic dermatitis.","volume":"33","author":"Lee","year":"2021","journal-title":"Ann Dermatol"},{"issue":"9","key":"zoi240746r13","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1345\/aph.1P098","article-title":"Pediatric atopic dermatitis: a review of the medical management.","volume":"44","author":"Carbone","year":"2010","journal-title":"Ann Pharmacother"},{"issue":"4","key":"zoi240746r14","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/j.jaad.2017.09.074","article-title":"A systematic review of the safety and efficacy of systemic corticosteroids in atopic dermatitis.","volume":"78","author":"Yu","year":"2018","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"zoi240746r15","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/0002-9343(94)90131-7","article-title":"Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events.","volume":"96","author":"Saag","year":"1994","journal-title":"Am J Med"},{"issue":"9","key":"zoi240746r16","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.1007\/s00198-013-2352-3","article-title":"Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study.","volume":"24","author":"Majumdar","year":"2013","journal-title":"Osteoporos Int"},{"issue":"2","key":"zoi240746r17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2017-000209","article-title":"Monitoring long-term oral corticosteroids.","volume":"6","author":"Mundell","year":"2017","journal-title":"BMJ Open Qual"},{"issue":"7","key":"zoi240746r18","doi-asserted-by":"publisher","first-page":"833","DOI":"10.18553\/jmcp.2016.22.7.833","article-title":"Dose-response relationship between long-term systemic corticosteroid use and related complications in patients with severe asthma.","volume":"22","author":"Dalal","year":"2016","journal-title":"J Manag Care Spec Pharm"},{"issue":"4","key":"zoi240746r19","doi-asserted-by":"publisher","first-page":"268","DOI":"10.2500\/aap.2015.36.3863","article-title":"Risk of corticosteroid-related adverse events in asthma patients with high oral corticosteroid use.","volume":"36","author":"Zazzali","year":"2015","journal-title":"Allergy Asthma Proc"},{"issue":"1","key":"zoi240746r20","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jaci.2017.04.009","article-title":"Oral corticosteroid exposure and adverse effects in asthmatic patients.","volume":"141","author":"Sullivan","year":"2018","journal-title":"J Allergy Clin Immunol"},{"issue":"4","key":"zoi240746r21","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1016\/j.jaip.2016.12.023","article-title":"Burden of chronic oral corticosteroid use by adults with persistent asthma.","volume":"5","author":"Zeiger","year":"2017","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"1","key":"zoi240746r22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/pai.2009.20.issue-1","article-title":"Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis: differences between boys and girls?","volume":"20","author":"Glazenburg","year":"2009","journal-title":"Pediatr Allergy Immunol"},{"issue":"2","key":"zoi240746r23","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1111\/j.1365-2133.2010.10030.x","article-title":"Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials.","volume":"164","author":"Schmitt","year":"2011","journal-title":"Br J Dermatol"},{"issue":"3","key":"zoi240746r24","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1111\/jdv.v35.3","article-title":"Atopic dermatitis and bone health: a systematic review.","volume":"35","author":"Mukovozov","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"8","key":"zoi240746r25","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1111\/ced.v45.8","article-title":"What\u2019s new in atopic eczema? an analysis of systematic reviews published in 2018, part 1: prevention and topical therapies.","volume":"45","author":"Tasker","year":"2020","journal-title":"Clin Exp Dermatol"},{"issue":"4","key":"zoi240746r26","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1177\/0009922818825154","article-title":"Low risk of adrenal insufficiency after use of low- to moderate-potency topical corticosteroids for children with atopic dermatitis.","volume":"58","author":"Davallow Ghajar","year":"2019","journal-title":"Clin Pediatr (Phila)"},{"issue":"6","key":"zoi240746r27","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1159\/000489125","article-title":"Evaluation of hypothalamic-pituitary-adrenal axis suppression following cutaneous use of topical corticosteroids in children: a meta-analysis.","volume":"89","author":"Wood Heickman","year":"2018","journal-title":"Horm Res Paediatr"},{"issue":"6","key":"zoi240746r28","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.11124\/JBISRIR-2017-003393","article-title":"Long-term topical corticosteroid use and risk of skin cancer: a systematic review.","volume":"16","author":"Ratib","year":"2018","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"2","key":"zoi240746r29","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1111\/bjd.2007.156.issue-2","article-title":"A systematic review of the safety of topical therapies for atopic dermatitis.","volume":"156","author":"Callen","year":"2007","journal-title":"Br J Dermatol"},{"key":"zoi240746r30","first-page":"0","article-title":"Prevalence of atopic dermatitis in the adult population of Catalonia (Spain): a retrospective, large-scale population-based study.","volume":"0","author":"Mora","year":"2023","journal-title":"J Investig Allergol Clin Immunol"},{"issue":"8","key":"zoi240746r31","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1080\/09546634.2019.1639604","article-title":"Treatment patterns in UK adult patients with atopic dermatitis treated with systemic immunosuppressants: data from The Health Improvement Network (THIN).","volume":"31","author":"Eckert","year":"2020","journal-title":"J Dermatolog Treat"},{"issue":"8","key":"zoi240746r33","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"6","key":"zoi240746r34","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1016\/j.jaci.2015.07.046","article-title":"Acute and chronic systemic corticosteroid-related complications in patients with severe asthma.","volume":"136","author":"Lefebvre","year":"2015","journal-title":"J Allergy Clin Immunol"},{"issue":"6","key":"zoi240746r35","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1359\/jbmr.2000.15.6.993","article-title":"Use of oral corticosteroids and risk of fractures.","volume":"15","author":"Van Staa","year":"2000","journal-title":"J Bone Miner Res"},{"issue":"12","key":"zoi240746r36","doi-asserted-by":"publisher","first-page":"E295","DOI":"10.1503\/cmaj.191012","article-title":"Oral glucocorticoids and incidence of hypertension in people with chronic inflammatory diseases: a population-based cohort study.","volume":"192","author":"Mebrahtu","year":"2020","journal-title":"CMAJ"},{"key":"zoi240746r37","doi-asserted-by":"publisher","first-page":"41","DOI":"10.2147\/OARRR.S245662","article-title":"Correlation between steroid therapy and lipid profile in systemic lupus erythematosus patients.","volume":"12","author":"Atik","year":"2020","journal-title":"Open Access Rheumatol"},{"issue":"2","key":"zoi240746r38","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.atherosclerosis.2006.05.019","article-title":"Use of oral corticosteroids and the risk of acute myocardial infarction.","volume":"192","author":"Varas-Lorenzo","year":"2007","journal-title":"Atherosclerosis"},{"key":"zoi240746r39","doi-asserted-by":"publisher","first-page":"449","DOI":"10.2174\/1874325001206010449","article-title":"Glucocorticoid-induced avascular bone necrosis: diagnosis and management.","volume":"6","author":"Chan","year":"2012","journal-title":"Open Orthop J"},{"issue":"4","key":"zoi240746r40","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/S0030-5898(20)30431-4","article-title":"Fat embolism and osteonecrosis.","volume":"16","author":"Jones","year":"1985","journal-title":"Orthop Clin North Am"},{"issue":"7","key":"zoi240746r41","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.2106\/00004623-199707000-00012","article-title":"Steroid-induced adipogenesis in a pluripotential cell line from bone marrow.","volume":"79","author":"Cui","year":"1997","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"zoi240746r42","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1111\/j.1444-0938.2002.tb03011.x","article-title":"What causes steroid cataracts? a review of steroid-induced posterior subcapsular cataracts.","volume":"85","author":"Jobling","year":"2002","journal-title":"Clin Exp Optom"},{"issue":"5","key":"zoi240746r43","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1089\/jop.2006.0067","article-title":"The etiology of steroid cataract.","volume":"23","author":"James","year":"2007","journal-title":"J Ocul Pharmacol Ther"},{"issue":"5","key":"zoi240746r44","doi-asserted-by":"publisher","first-page":"1803","DOI":"10.1172\/JCI111599","article-title":"Nonenzymatic addition of glucocorticoids to lens proteins in steroid-induced cataracts.","volume":"74","author":"Manabe","year":"1984","journal-title":"J Clin Invest"},{"key":"zoi240746r45","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/789623","article-title":"Advances in corticosteroid therapy for ocular inflammation: loteprednol etabonate.","volume":"2012","author":"Comstock","year":"2012","journal-title":"Int J Inflam"},{"issue":"5","key":"zoi240746r46","doi-asserted-by":"publisher","first-page":"718","DOI":"10.3346\/jkms.2017.32.5.718","article-title":"Towards actualizing the value potential of Korea Health Insurance Review and Assessment (HIRA) data as a resource for health research: strengths, limitations, applications, and strategies for optimal use of HIRA data.","volume":"32","author":"Kim","year":"2017","journal-title":"J Korean Med Sci"},{"issue":"1","key":"zoi240746r47","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1159\/000246781","article-title":"Frequency and significance of the major and minor features of Hanifin and Rajka among patients with atopic dermatitis.","volume":"189","author":"Rudzki","year":"1994","journal-title":"Dermatology"},{"issue":"2","key":"zoi240746r48","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.jaad.2013.10.010","article-title":"Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.","volume":"70","author":"Eichenfield","year":"2014","journal-title":"J Am Acad Dermatol"},{"key":"zoi240746r32","unstructured":"Park? BJ, Sung? SJ, Park? KD, Seo? SW, Kim? SW. Report of the evaluation for validity of discharged diagnoses in Korean Health Insurance database. ScienceOpen.com. 2003. Accessed May 28, 2023. https:\/\/www.scienceopen.com\/document?vid=fdacfead-9b03-4426-a8cb-349e463b8aff"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2821349\/jang_2024_oi_240746_1720720601.42609.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T17:01:36Z","timestamp":1721408496000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2821349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,19]]},"references-count":48,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.23563","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,19]]}}}