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Background <p>Sustained exposure to oral corticosteroids (OCS) increases the risk of upper gastrointestinal bleeding (UGIB). It is uncertain whether short-term OCS treatment of asthma exacerbations increases this risk. This study aims to estimate the risk of acute UGIB after transient OCS use in patients with mild-to-moderate asthma.</p> Methods <p>We used a case-crossover design within a cohort of patients with mild-to-moderate asthma, aged 18–40 years during 2000–2023, from the UK’s Clinical Practice Research Datalink. Subjects who experienced a first severe UGIB formed the case series. Short-term OCS was defined by a prescription for ≤ 14 days, with a 30-day residual effect period. For each case, the UGIB event date and 6 control dates, selected at 45-day intervals in the prior year, were considered exposed if the prescription spanned the date. The odds ratio (OR) of UGIB was estimated using conditional logistic regression, adjusted for time-varying use of asthma inhalers and medications related to bleeding risks.</p> <p>Findings</p> <p>The cohort involved 655,217 patients&#xa0;with mild-to-moderate asthma, with 743 experiencing a first UGIB who received 1160 OCS prescriptions in the past year. The crude and adjusted ORs of UGIB after OCS use versus non-use was 1.12 (95% confidence interval [CI]: 0.92–1.37), and 1.12 (95% CI: 0.91–1.36), respectively. Higher OCS-related UGIB risk was observed during periods of no inhaled corticosteroid (ICS) use, but not during periods of regular ICS use.</p> Conclusion <p>Short-term OCS use does not increase UGIB risk in patients with mild-to-moderate asthma. There may be interaction between OCS and ICS in affecting UGIB risk in this patient population.</p>

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Transient Oral Corticosteroid Use and Acute Upper Gastrointestinal Bleeding in Mild-to-Moderate Asthma: A Case-Crossover Study

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Jiaying Li,
  • Pierre Ernst,
  • Samy Suissa

摘要

Background

Sustained exposure to oral corticosteroids (OCS) increases the risk of upper gastrointestinal bleeding (UGIB). It is uncertain whether short-term OCS treatment of asthma exacerbations increases this risk. This study aims to estimate the risk of acute UGIB after transient OCS use in patients with mild-to-moderate asthma.

Methods

We used a case-crossover design within a cohort of patients with mild-to-moderate asthma, aged 18–40 years during 2000–2023, from the UK’s Clinical Practice Research Datalink. Subjects who experienced a first severe UGIB formed the case series. Short-term OCS was defined by a prescription for ≤ 14 days, with a 30-day residual effect period. For each case, the UGIB event date and 6 control dates, selected at 45-day intervals in the prior year, were considered exposed if the prescription spanned the date. The odds ratio (OR) of UGIB was estimated using conditional logistic regression, adjusted for time-varying use of asthma inhalers and medications related to bleeding risks.

Findings

The cohort involved 655,217 patients with mild-to-moderate asthma, with 743 experiencing a first UGIB who received 1160 OCS prescriptions in the past year. The crude and adjusted ORs of UGIB after OCS use versus non-use was 1.12 (95% confidence interval [CI]: 0.92–1.37), and 1.12 (95% CI: 0.91–1.36), respectively. Higher OCS-related UGIB risk was observed during periods of no inhaled corticosteroid (ICS) use, but not during periods of regular ICS use.

Conclusion

Short-term OCS use does not increase UGIB risk in patients with mild-to-moderate asthma. There may be interaction between OCS and ICS in affecting UGIB risk in this patient population.