P27 - Real word incidence of adrenal insufficiency after long-term use of systemic and inhaled corticosteroids

Abstract Background/Introduction The incidence of adrenal insufficiency following chronic use of both systemic and inhaled corticosteroids remains poorly known. Purpose The aim of our study was to assess the incidence of hospitalization for adrenal insufficiency (AI) after long-term use of systemic and inhaled corticosteroids in a large population-based cohort. Methods We used TriNetx Research Collaborative network, with access to electronic medical records from a number of participating health care organizations, to identify participants. Diagnosis was done using the International Classification of Diseases codes, and data on medications were studied. We included individuals who were treated with long-term systemic or inhaled only corticosteroids. We excluded those with a past history of causes of primary and secondary adrenocortical insufficiency. We used a 1:1 propensity-score to compare matched subjects treated by long term systemic (n=243,430) or inhaled (n=315,237) steroid to subjects treated by NSAID only. Results Mean age of the population studied was 56.5 ± 18 years, with 40% of men. Over a mean follow-up of 2.4 ± 1.9 years, long-term systemic corticosteroids use was associated with a more frequent diagnosis of AI (0.20% vs 0.04% per year; HR: 6.32, 95%CI [5.50-7.26], p<0.001) and a greater incidence of hospitalization for AI (0.02% vs 0.008% per year; HR: 3.52, 95%CI [2.57-4.84], p<0.001) as compared to individuals treated with NSAID. Long-term inhaled corticosteroids use was associated with a more common diagnosis of AI (0.05% vs 0.04% per year; HR: 1.55, 95%CI [1.34-1.80], p<0.001), without increased risk of hospitalization for AI (0.01% vs 0.01% per year; HR: 1.26, 95%CI [0.91-1.76], p=0.17) as compared to NSAID therapy. Conclusion(s) Long-term use of systemic corticosteroids was associated with an increased risk of diagnosed AI with a greater incidence of hospitalization for AI over a 2.4-year follow-up. Inhaled corticosteroids use was associated with an increased incidence of diagnosed AI. These findings from a large real world-based cohort underscore the importance of preventing the onset of corticotropic insufficiency among individuals with long-term corticosteroids treatment.