RT Journal Article
SR Electronic
T1 Long-term oral prednisolone exposure in primary care for bullous pemphigoid: population-based study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP BJGP.2020.0870
DO 10.3399/BJGP.2020.0870
A1 Monica SM Persson
A1 Karen E Harman
A1 Kim S Thomas
A1 Joanne Chalmers
A1 Yana Vinogradova
A1 Sinéad Langan
A1 Julia Hippisley-Cox
A1 Sonia Gran
YR 2021
UL http://bjgp.org/content/early/2021/08/09/BJGP.2020.0870.abstract
AB Background: Oral prednisolone is the mainstay treatment for bullous pemphigoid, an auto-immune blistering skin disorder affecting older people. Moderate to high dose treatment 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 1998-2017. 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: 2,312 (69.6%) of 3,322 people with bullous pemphigoid were prescribed oral prednisolone in primary care. The median duration of exposure was 10.6 months (IQR 3.4 to 24.0). Of prednisolone users, 71.5% were continuously exposed for >3 months, 39.8% for >1 year, 14.7% for >3 years, 5.0% for >5 years, and 1.7% for >10 years. The median cumulative dose was 2,974mg (IQR 1,059 to 6,456). Maximum daily doses were ≥10mg/day in 74.4% of users, ≥20mg/day in 40.7%, ≥30mg/day in 18.2%, ≥40mg/day in 6.6%, ≥50mg/day in 3.8%, and ≥60mg/day in 1.9%. Conclusions: A high proportion of people with incident bullous pemphigoid are treated with oral prednisolone in UK primary care. Primary and secondary care should address steroid-sparing alternatives and, where switching is not possible, ensure prophylactic treatments and proactive monitoring of potential side-effects are in place.