Atopic Dermatitis Treatment Caution: Long-Term Oral Corticosteroid Use Ups Cardiovascular and Thrombotic Risks

Individuals with atopic dermatitis (AD) using prolonged oral corticosteroids (OCS) face an 81% increased risk of venous thromboembolism (VTE) and 24% higher risk of major adverse cardiovascular events (MACE) compared to short-term users, according to research presented at the Society for Investigative Dermatology Annual Meeting, May 7-10, 2025, in San Diego.1

The retrospective cohort study analyzed data from more than 52,000 US participants aged 12 years and older with a documented diagnosis of AD. According to investigators, the research provides the first quantitative risk assessment of extended OCS use specific to the AD population and underscores the importance of careful risk-benefit analysis if long-term OCS use is a therapeutic consideration.1

International guidelines and expert consensus reports recommend use of oral corticosteroids be avoided or limited to short-term use as rescue therapy only.2 The potential and well-known adverse effects of high doses used for prolonged periods include cardiovascular and thrombotic events. Additional evidence has shown similar risks with low-to-moderate doses as well.3 First author Mark Lebwohl, MD, and fellow investigators note, however, that the preponderance of evidence for the cardiovascular outcomes has been observed in individuals with other immune-mediated diseases such as asthma, lupus, and rheumatoid arthritis.1

For their study of the relationship between prolonged OCS use and vascular complications in individuals with AD, Lebwohl et al tapped the Optum Clinformatics Data Mart. Data were collected for eligible participants who began oral corticosteroid therapy during the 2-year study period.1

The research team classified participants according to pattern of OCS use: short-term use was defined as a single prescription covering 30 days or fewer or 2 prescriptions within a single month; prolonged use was defined as 1 or more prescriptions covering more than 30 days or multiple prescriptions with longer durations. Lebwohl and colleagues used a clone-censor-weight analysis to approximate a hypothetical per-protocol trial, comparing MACE and VTE risks between the 2 groups over the 2-year follow-up.

FINDINGS

The findings in this focused AD cohort were similar to those seen in other populations treated long-term with OCS. According to the study abstract, crude MACE incidence reached 3.07 events per 100 person-years (PY) in the prolonged-use group compared with 2.62 in the short-term group. The rates for VTE were reported as 0.43 and 0.16 per 100 PY, respectively. Analysis revealed a cumulative probability of experiencing a vascular event over 2 years of approximately 4% in the prolonged treatment group compared to 3% in the short-term group. The differences in VTE risk showed greater separation, with 2-year probabilities of approximately 0.6% in prolonged- vs 0.3% in short-term use.1

After multivariable adjustment for participants' baseline characteristics, data demonstrated that prolonged OCS use compared with shorter duration resulted in the 81% increase in risk of VTE and 24% higher risk of MACE noted earlier. Kaplan-Meier survival curves demonstrated clear divergence in event-free survival over time, further confirming that extended oral steroid therapy correlates with increased cardiovascular and thrombotic complications, according to the study abstract.1

Overall, the study results align with existing international clinical guidelines cautioning against routine long-term OCS use.

The authors acknowledged several limitations to the study that may limit generalizability of the findings, including the observational design, potential residual confounding, and focus on a US population.

"Characterizing prolonged oral CS use and the associated cardiovascular and thrombotic risk among patients with AD may help inform treatment benefit-risk assessments," noted Lebwohl and colleagues.

References

1. Lebwohl M, Bunick C, Vleugels RA, et al. Cardiovascular and thrombosis risks of prolonged versus short-term use of oral corticosteroids among atopic dermatitis patients in the United States. Poster presented at: Society for Investigative Dermatology Annual Meeting; May 7-10, 2025; San Diego, California.

2. Davis DMR, Drucker AM, Alikhan A, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024;90(2):e43-e56. doi:10.1016/j.jaad.2023.08.102

3. 3. Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J. Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study. PLoS Med. 2020; 17(12):e1003432. doi:10.1371/journal.pmed.1003432