Patients and healthcare professionals alike are concerned about the side effects* of steroids, especially the increased chance of developing osteoporosis, diabetes, and cardiovascular diseases (van der Goes 2009). Yet, patients with vasculitis (a collection of rare conditions of inflamed blood vessels) rely on steroids. Efforts to develop new drugs, with fewer side effects, have been made so steroids can be used less, but they are very expensive (hence they are often referred to as ‘high-cost’ drugs). It is also unclear whether all patients have the same chances of being prescribed them and how this might have changed because of the COVID-19 pandemic.
For two example rare diseases we will explore steroid use and side effects in England, before and after the COVID-19 pandemic, using patients’ medical records. We will focus on anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (rare) and Takayasu arteritis (extremely rare) as the number of people with these diseases in England is also not precisely known for informing healthcare planning. First, we will find all the patients with these conditions. Then we will count the amount and dose of steroids they are prescribed. If possible, we will report this for different regions in England to see if there is any variation in steroid use. Higher steroid use is likely to occur where high-cost drug prescribing is lower. We will also compare numbers of deaths, visits to hospital, and new illnesses such as type 2 diabetes and high blood pressure, by amount of steroid used. Where there is enough data, we will report our results broken down by age, sex, ethnicity, geographical area, and deprivation.
Looking over time will enable us to see how steroid prescribing and the risk of side effects changed before and after the COVID-19 pandemic. This will allow us to make recommendations for both local and national policy.
*Please note we are using the terms ‘side effect’ and ‘toxicity’ interchangeably for the purpose of this project.
Reference:
van der Goes MC et al. Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2010 Jun;69(6):1015-21.