This retrospective nested case-control study examined the association between oral corticosteroid (OCS) exposure and systemic adverse events in 165,361 adult patients (≥20 years) with incident chronic rhinosinusitis with nasal polyps (CRSwNP), using South Korea's national insurance database (2010–2023). OCS exposure was measured by annual duration, cumulative dose, and prescription frequency.
Among 523,316 matched patients (51,647 cases; 472,369 controls), high OCS exposure (>90 days/year) significantly raised risk of avascular bone necrosis, osteoporosis, and pneumonia. Cumulative dose ≥1.0 g prednisolone-equivalents/year was linked to a 23% higher overall adverse event risk (aOR 1.23; 95% CI 1.11–1.36), plus elevated risks of avascular bone necrosis, pneumonia, dyslipidemia, heart failure, hypertension, and type 2 diabetes. Prescription frequency alone was not independently associated with risk.
- Retrospective claims-data design limits ability to confirm diagnosis accuracy or capture over-the-counter steroid use. - Study population is Korean adults only, which may limit generalizability to other ethnicities or healthcare systems. - Residual confounding (e.g., disease severity, comorbidities driving OCS use) cannot be fully excluded.
Limit cumulative and annual OCS exposure in CRSwNP patients — doses ≥1.0 g/year prednisolone-equivalent carry measurable systemic harm. Prioritize steroid-sparing strategies (e.g., biologics, endoscopic sinus surgery) for patients requiring long-term disease control.
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