Risk of hospitalization for adrenal insufficiency following long-term systemic and inhaled corticosteroid use: a comparative TriNetX network analysis.

OBJECTIVE

Limited data exist regarding the incidence of glucocorticoid-induced adrenal insufficiency (AI). The incidence of hospitalization for AI remains poorly characterized. In a retrospective propensity score-matched cohort study, we assessed the incidence of AI and hospitalization for AI in patients receiving long-term systemic or inhaled corticosteroids compared with those receiving nonsteroidal anti-inflammatory drugs (NSAIDs).

DESIGN/

METHODS

Participants were recruited from the TriNetX Research Collaborative network. Using propensity score matching (1:1), we compared adults receiving long-term (>3 months) systemic or inhaled corticosteroids with those treated with NSAIDs. We assessed the rates of AI diagnosis and hospitalization for AI in the two groups.

RESULTS

After matching, 243 430 patients on systemic corticosteroids and 315 237 patients on inhaled corticosteroids were compared with corresponding NSAID-treated controls. Mean age was 56.5 ± 18 years. Over a mean follow-up of 2.4 ± 1.9 years, long-term systemic corticosteroid use was associated with higher rates of AI diagnosis (0.20% vs 0.04% per year; HR 6.32, 95% CI 5.50-7.26, P < .001) and hospitalization for AI (0.02% vs 0.008% per year; HR 3.52, 95% CI 2.57-4.84, P < .001). Inhaled corticosteroid use was associated with increased AI diagnosis (0.05% vs 0.04% per year; HR 1.55, 95% CI 1.34-1.80, P < .001) but not with hospitalization for AI (HR 1.26, 95% CI 0.91-1.76, P = .17).

CONCLUSIONS

Long-term systemic corticosteroid use substantially increases the risk of both AI diagnosis and hospitalization for AI. Inhaled corticosteroids confer a modest increase in AI diagnosis without significantly elevating hospitalization risk.