Topical corticosteroids linked to peptic ulcer risk
Patients using long-term topical corticosteroids for atopic dermatitis were at significantly higher risk for upper GI complications, especially if they were also taking systemic corticosteroids, NSAIDs, or aspirin, a study in Taiwan found.
Patients with atopic dermatitis who use long-term topical corticosteroids may be at higher risk for upper GI complications, a recent study found.
Researchers used Taiwan's National Health Insurance Research Database to perform a population-based, retrospective case-control study evaluating the association between long-term use of topical corticosteroids and risk for upper GI complications in patients with atopic dermatitis. Data between 2003 and 2019 were included. The researchers evaluated exposure to risk factors, including systemic corticosteroids, NSAIDs, and aspirin, within 90 days before the index date, with topical corticosteroid use documented for 90 days and one year before the index date. The results were published as a research letter Sept. 1 by Mayo Clinic Proceedings.
The study included 217,569 patients in the case and control groups, matched on age, sex, location, and Charlson comorbidity index. Cases had newly diagnosed upper GI complications with peptic ulcers (including gastric ulcers and duodenal ulcers), while controls did not. Cases were more likely to be exposed to aspirin, NSAIDs, and systemic corticosteroids than controls.
Upper GI complications were significantly associated with exposure to topical corticosteroids within 90 days and one year (adjusted odds ratios [OR], 1.676 [95% CI, 1.639 to 1.713] and 1.738 [95% CI, 1.712 to 1.764], respectively). Risk was higher with higher versus lower cumulative long-term exposure (adjusted ORs, 1.799 [95% CI, 1.762 to 1.837] and 1.691 [95% CI, 1.660 to 1.724], respectively).
In subgroup analyses, patients ages 65 years and older and male patients had a greater increase in risk with topical corticosteroid use. Patients who were exposed only to topical corticosteroids had a much lower increase in risk for upper GI complications (adjusted OR, 1.782; 95% CI, 1.733 to 1.832) than those who were also exposed to systemic corticosteroids, NSAIDs, or aspirin (adjusted OR, 8.189; 95% CI, 5.108 to 13.128).
The study was limited by its lack of information about severity of atopic dermatitis, the authors noted. They concluded that long-term use of topical corticosteroids was associated with increased risk of upper GI complications in patients with atopic dermatitis and that higher cumulative exposure was linked to higher risk. “Concurrent use of TCSs [topical corticosteroids] with systemic corticosteroids, NSAIDs, or [aspirin] further amplifies this risk,” they wrote. “Clinicians should consider preventive strategies for [upper GI] complications, especially in older patients requiring prolonged TCS treatment.”