Prescriptions of corticosteroids in primary care and related clinical indications: a national population-based cohort study in England

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Background Corticosteroids are widely prescribed in primary care for a broad range of inflammatory and autoimmune conditions. Despite their therapeutic benefits, corticosteroids are associated with adverse effects, particularly with long-term use. We aimed to describe corticosteroid prescribing patterns to better understand the current landscape of corticosteroid use in England. Methods We conducted a population-based cohort study using electronic health-care records from the Clinical Practice Research Datalink Aurum. The study population included adults (aged 18 years or older) who were alive, registered with a general practice in England, and had at least one corticosteroid prescription between Jan 1 and Dec 31, 2023 (the period of follow-up). The study population (age, sex, and ethnicity) and corticosteroid characteristics (drug substance and duration of use) were described by route of administration. Outcomes included pre-defined clinical indications across disease systems and were defined in the 2-year window prior to the patients' first corticosteroid prescription up until their last corticosteroid prescription and described by route of administration. Finally, combinations of disease systems were described. This study was registered with Clinical Practice Research Datalink (erap number 25_004991). Findings Between Jan 1 and Dec 31, 2023, 12 029 952 unique corticosteroids were prescribed to 2 564 729 patients. Median age of patients was 56·5 years (IQR 40·5–70·5), 1 466 264 (57·2%) of the population were female, 1 999 601 (78·0%) were White, 207 228 (8·1%) were South Asian, 77 205 (3·0%) were Black, 33 239 (1·3%) were Mixed, 53 202 (2·1%) were of Other ethnicity, and 194 254 (7.6%) had missing ethnicity. The median number of corticosteroids prescribed per person over the year of follow-up was two (IQR 1–6). Inhaled corticosteroids accounted for the highest number of prescriptions (44·2%), followed by cutaneous (19·6%), nasal (14·3%), and oral (14·0%) routes. 1 267 685 (49·4%) patients had at least one pre-defined clinical indication recorded up to 2 years prior. Asthma (801 924 [63·3%]), eczema (229 382 [18·1%]), and chronic obstructive pulmonary disease (220 759 [17·4%]) were the most frequently recorded indications for all corticosteroids. Among patients with multiple indications, the most common combination was respiratory and dermatology-related disease with 53·8% of patients receiving corticosteroid treatment for both types of diseases. Interpretation Corticosteroid prescribing remains widespread in primary care in England. These findings highlight the need to evaluate safer therapeutic alternatives and update current guidelines for potentially reducing corticosteroid exposures. Funding None.

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