Oral corticosteroid overexposure: characterizing oral corticosteroid use in patients with chronic rhinosinusitis with nasal polypS in Canada (ACTIONS) results
Bibliographic record
Abstract
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory condition, often treated with oral corticosteroids (OCS). OCS overexposure can increase the risk of adverse effects, highlighting the need for better treatment strategies including timely biologic therapy use. This study explored OCS use patterns in patients with severe CRSwNP in Canada pre-biologic initiation. METHODS: This retrospective, real-world study used IQVIA's Private Drug Plan (PDP) claims database to examine OCS use patterns 0-24 months pre-initiation of biologic therapy in patients with inferred CRSwNP in Canada (n = 747). Outcomes included OCS use patterns (proportions, claims per patient and by prescribing physician specialty, overexposure [≥ 1000 mg annually, prednisone-equivalent]), demographics, and stratified by comorbid asthma. RESULTS: Of 747 patients indexed from the PDP, 81.0% had ≥ 1 OCS claim(s), with a median (interquartile range [IQR]) of 3.0 (4.0) claims per patient. Median (IQR) total OCS dose over 24 months was 1020 (1420) mg; 41.5% of patients experienced OCS overexposure. OCS was primarily prescribed by general practitioners (35.9%) and otolaryngologists (32.8%). Patients had a median (IQR) age of 51 (18) years at index, 52.1% were male, and most were from Ontario (48.7%). OCS use was highest in patients with comorbid severe asthma. CONCLUSIONS: This study highlights OCS overexposure in patients with CRSwNP pre-biologic initiation. Enhancing physician and patient awareness of appropriate OCS use and timely biologic initiation could reduce the risk of OCS-related adverse effects and improve CRSwNP management, benefiting long-term patient outcomes through shared decision-making. Trial registration GSK study number 221872.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".