{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:59:19Z","timestamp":1786636759964,"version":"build-2736575974"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec id=\"ab-ooi260028-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Oral corticosteroids are commonly used in the management of chronic rhinosinusitis with nasal polyps to control inflammation. However, evidence on the long-term safety of repeated or high-dose oral corticosteroid exposure in this population remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260028-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the association between oral corticosteroid exposure and systemic adverse events in patients with chronic rhinosinusitis with nasal polyps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260028-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>A retrospective, nationwide, nested case-control study included adult patients (\u226520 years) with incident chronic rhinosinusitis with nasal polyps, excluding those with prior immune-mediated diseases or outcome diagnoses, using the Korean Health Insurance Review and Assessment Service database (2010-2023). Data analysis was conducted from March 2025 to April 2026. Patients who developed adverse events (case patients) were matched 1:10 with controls by age, sex, and diagnosis date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260028-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Oral corticosteroid exposure was quantified using 3 metrics: exposure intensity (annual duration: low [\u226430 days], moderate [31-90 days], or high [&amp;amp;gt;90 days]), cumulative dose (&amp;amp;lt;0.5 g, 0.5-1.0 g, or \u22651.0 g prednisolone-equivalents per year), and prescription frequency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260028-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>First occurrence of systemic adverse events. Adjusted odds ratios and 95% CIs were estimated using multivariable conditional logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260028-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 165\u202f361 patients with chronic rhinosinusitis with nasal polyps who were prescribed at least 1 oral corticosteroid were identified. The matched cohort included 523\u202f316 patients (51\u202f647 case patients and 472\u202f369 controls; mean [SD] midpoint approximated age, 47.1 [13.9] years; 39.7% women). High exposure intensity (&amp;amp;gt;90 days per year) was associated with a significantly increased risk of avascular bone necrosis, osteoporosis, and pneumonia. A cumulative dose greater than 1.0 g per year was associated with a 23% higher overall adverse event risk (adjusted odds ratio, 1.23; 95% CI, 1.11-1.36) and increased risks of avascular bone necrosis, pneumonia, dyslipidemia, heart failure, hypertension, and type 2 diabetes. Prescription frequency was not independently associated with adverse event risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260028-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this nested case-control study within a nationwide cohort of patients with chronic rhinosinusitis with nasal polyps, higher oral corticosteroid exposure, in terms of annual duration and cumulative dose, was associated with an increased risk of systemic adverse events, particularly musculoskeletal and infection-related complications. These findings underscore the need for steroid-sparing treatment strategies for long-term management of chronic rhinosinusitis with nasal polyps.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2026.1188","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T15:30:32Z","timestamp":1780587032000},"page":"735","source":"Crossref","is-referenced-by-count":1,"title":["Oral Corticosteroids and Adverse Events in Chronic Rhinosinusitis With Nasal Polyps"],"prefix":"10.1001","volume":"152","author":[{"given":"Seojin","family":"Moon","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Yongin Severance Hospital, Gyeonggi-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myeongjee","family":"Lee","sequence":"additional","affiliation":[{"name":"Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inkyung","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Seok","family":"Rha","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea"},{"name":"The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"ooi260028r1","doi-asserted-by":"publisher","first-page":"134","DOI":"10.2500\/ajra.2016.30.4297","article-title":"Chronic rhinosinusitis: epidemiology and burden of disease.","volume":"30","author":"DeConde","year":"2016","journal-title":"Am J Rhinol Allergy"},{"issue":"5","key":"ooi260028r2","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1111\/all.15982","article-title":"EUFOREA\/EPOS2020 statement on the clinical considerations for chronic rhinosinusitis with nasal polyps care.","volume":"79","author":"Hellings","year":"2024","journal-title":"Allergy"},{"issue":"2","key":"ooi260028r3","doi-asserted-by":"publisher","first-page":"129","DOI":"10.4193\/Rhino11.256","article-title":"Prevalence of chronic rhinosinusitis in Sao Paulo.","volume":"50","author":"Pilan","year":"2012","journal-title":"Rhinology"},{"issue":"9","key":"ooi260028r4","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1111\/j.1398-9995.2011.02646.x","article-title":"Chronic rhinosinusitis in Europe\u2014an underestimated disease. A GA2LEN study.","volume":"66","author":"Hastan","year":"2011","journal-title":"Allergy"},{"issue":"6","key":"ooi260028r5","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/j.jaip.2022.01.016","article-title":"Epidemiology of chronic rhinosinusitis: prevalence and risk factors.","volume":"10","author":"Sedaghat","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"6","key":"ooi260028r6","doi-asserted-by":"publisher","first-page":"585","DOI":"10.4168\/aair.2024.16.6.585","article-title":"Revisiting T cells in chronic rhinosinusitis.","volume":"16","author":"Moon","year":"2024","journal-title":"Allergy Asthma Immunol Res"},{"issue":"8","key":"ooi260028r7","doi-asserted-by":"publisher","first-page":"2113","DOI":"10.1111\/all.16569","article-title":"Burden of oral corticosteroid use in severe asthma: challenges and opportunities.","volume":"80","author":"Canonica","year":"2025","journal-title":"Allergy"},{"issue":"4","key":"ooi260028r8","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011996.pub2","article-title":"Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis.","volume":"4","author":"Chong","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"ooi260028r9","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1053\/hn.2003.v128.amhn0312811","article-title":"Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology.","volume":"129","author":"Benninger","year":"2003","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi260028r10","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1136\/ard.61.8.718","article-title":"Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology.","volume":"61","author":"Buttgereit","year":"2002","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"ooi260028r11","doi-asserted-by":"publisher","first-page":"661","DOI":"10.2307\/2530047","article-title":"Covariance adjustment of relative-risk estimates in matched studies.","volume":"38","author":"Breslow","year":"1982","journal-title":"Biometrics"},{"key":"ooi260028r12","doi-asserted-by":"publisher","first-page":"h1551","DOI":"10.1136\/bmj.h1551","article-title":"Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES Consortium.","volume":"350","author":"Mons","year":"2015","journal-title":"BMJ"},{"issue":"4","key":"ooi260028r13","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value.","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"issue":"1","key":"ooi260028r14","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.jaci.2006.03.012","article-title":"Short course of systemic corticosteroids in sinonasal polyposis: a double-blind, randomized, placebo-controlled trial with evaluation of outcome measures.","volume":"118","author":"Hissaria","year":"2006","journal-title":"J Allergy Clin Immunol"},{"issue":"4","key":"ooi260028r15","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011992.pub2","article-title":"Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis.","volume":"4","author":"Head","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"ooi260028r16","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011991.pub2","article-title":"Short-course oral steroids alone for chronic rhinosinusitis.","volume":"4","author":"Head","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ooi260028r17","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1075066","article-title":"Effect of postoperative systemic prednisolone on short-term and long-term outcomes in chronic rhinosinusitis with nasal polyps: a multi-centered randomized clinical trial.","volume":"14","author":"Mueller","year":"2023","journal-title":"Front Immunol"},{"issue":"1","key":"ooi260028r18","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.amjoto.2018.09.005","article-title":"Differential effects of postoperative oral corticosteroid on eosinophilic vs. non-eosinophilic CRSwNP subtypes.","volume":"40","author":"Shen","year":"2019","journal-title":"Am J Otolaryngol"},{"issue":"6","key":"ooi260028r19","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.anai.2024.10.015","article-title":"Quantifying corticosteroid burden in chronic rhinosinusitis with nasal polyps: a retrospective US database study.","volume":"134","author":"Han","year":"2025","journal-title":"Ann Allergy Asthma Immunol"},{"key":"ooi260028r20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13601-019-0303-6","article-title":"Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper.","volume":"10","author":"Hox","year":"2020","journal-title":"Clin Transl Allergy"},{"issue":"1","key":"ooi260028r21","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2165\/00003088-200544010-00003","article-title":"Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids.","volume":"44","author":"Czock","year":"2005","journal-title":"Clin Pharmacokinet"},{"issue":"2","key":"ooi260028r22","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s12020-011-9580-0","article-title":"Glucocorticoid-induced osteonecrosis.","volume":"41","author":"Weinstein","year":"2012","journal-title":"Endocrine"},{"key":"ooi260028r23","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":"24","key":"ooi260028r24","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2021.36.e177","article-title":"Osteonecrosis of the femoral head: an updated review of ARCO on pathogenesis, staging and treatment.","volume":"36","author":"Hines","year":"2021","journal-title":"J Korean Med Sci"},{"issue":"11","key":"ooi260028r25","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.autrev.2010.06.007","article-title":"Steroid induced osteonecrosis: an analysis of steroid dosing risk.","volume":"9","author":"Powell","year":"2010","journal-title":"Autoimmun Rev"},{"issue":"4","key":"ooi260028r26","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s100670200078","article-title":"Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment.","volume":"21","author":"Koo","year":"2002","journal-title":"Clin Rheumatol"},{"issue":"6","key":"ooi260028r27","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1093\/clinids\/11.6.954","article-title":"Risk of infectious complications in patients taking glucocorticosteroids.","volume":"11","author":"Stuck","year":"1989","journal-title":"Rev Infect Dis"},{"issue":"5","key":"ooi260028r28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002024","article-title":"Common infections in patients prescribed systemic glucocorticoids in primary care: a population-based cohort study.","volume":"13","author":"Fardet","year":"2016","journal-title":"PLoS Med"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2849423\/jamaotolaryngology_moon_2026_oi_260028_1786134664.62138.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:00:48Z","timestamp":1786633248000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2849423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":28,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2026.1188","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}