Corticosteroid-Associated Adverse Events in Chronic Spontaneous Urticaria: A US Claims Data Study

Dermatol Ther (Heidelb) https://doi.org/10.1007/s13555-026-01776-0 ORIGINAL RESEARCH Corticosteroid‑Associated Adverse Events in Chronic Spontaneous Urticaria: A US Claims Data Study Gil Yosipovitch Irina Pivneva · Dhaval Patil · Jonathan Rodrigues · Merin Kuruvilla · Tara Raftery · · Jason Doran · Arthur Voegel · James Signorovitch · Marc A. Riedl Received: February 26, 2026 / Accepted: April 20, 2026 © The Author(s) 2026, modified publication 2026 ABSTRACT Introduction: Chronic spontaneous urticaria (CSU) is a skin disorder for which short-course systemic corticosteroids are recommended only as rescue medication during acute exacerbations. Here, we describe real-world corticosteroid use, adverse events (AEs) occurring post-corticosteroid initiation, and health care resource utilization (HCRU) of patients with CSU in the USA. Methods: This retrospective cohort study used data from the US HealthVerity claims database of adults with diagnosed CSU (January 2016–March 2023). Only prescription and non-antihistamine Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s13555-026-01776-0 users. claims were included in the analysis of treatment patterns. In the AE and HCRU analyses, patients were stratified into five cohorts on the basis of total days of systemic corticosteroid supply as a proxy for duration of use: ≤ 31 days, > 31 to ≤ 60 days, > 60 days, ≥ 90 days (subcohort of > 60 days), and non-corticosteroid users. Results: Of 200,298 patients, corticosteroids were the most prescribed treatment (78.3% all; 68.2% systemic) following CSU diagnosis, excluding over-the-counter medication and antihistamines. The ten most common AEs occurring after systemic corticosteroid initiation (hypertension, lipid disorders, anxiety, obesity, fatigue, depression, diabetes, insomnia, cataracts, and gastritis) occurred in higher proportions of all corticosteroid user types versus nonusers. The proportion of patients experiencing G. Yosipovitch University of Miami, Coral Gables, FL, USA I. Pivneva · A. Voegel Analysis Group, Inc., Montréal, QC, Canada G. Yosipovitch (*) Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, 5555 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA e-mail: J. Doran Analysis Group, Inc., Washington, DC, USA D. Patil · J. Rodrigues · M. Kuruvilla Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA J. Signorovitch Analysis Group, Inc., Boston, MA, USA M. A. Riedl Division of Allergy and Immunology, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, USA T. Raftery Novartis Ireland Ltd., Dublin, Ireland Vol.:(0123456789) Dermatol Ther (Heidelb) AEs generally increased with longer duration of corticosteroid use. More frequent HCRU was generally observed after the first systemic corticosteroid prescription and with increasing duration of corticosteroid use. Conclusions: Patients with CSU who were prescribed corticosteroids reported a higher proportion of AEs and more frequent HCRU than those who were not. These trends in AEs and HCRU were more prominent with increasing duration of corticosteroid use. PLAIN LANGUAGE SUMMARY Chronic spontaneous urticaria (CSU) is a skin condition that causes red, raised, and itchy bumps (hives) and sometimes swelling for an unknown reason, lasting over 6 weeks. Corticosteroids, a type of medication that reduces inflammation, are prescribed to control severe and sudden increases in CSU symptoms but are only recommended for a short duration owing to the risk of side effects. In this study, we assessed how often corticosteroids were prescribed to patients after being diagnosed with CSU. We also assessed side effects and how often patients needed medical care (health care visits) in those who were prescribed corticosteroids and those who were not. Over 200,000 patients in the USA were studied using insurance records between January 2016 and March 2023. In patients diagnosed with CSU, corticosteroids were the most prescribed treatment (excluding over-the-counter medication and antihistamines). Patients who were prescribed corticosteroids experienced more side effects and had more health care visits than those who were not. Side effects included elevated blood pressure, lipid disorders (abnormal levels of fats in the blood), and anxiety. Additionally, patients who took corticosteroids for a longer time experienced more side effects and more frequent health care visits. This study suggests that patients taking corticosteroids as a treatment for CSU were more likely to have side effects and need medical care. Where possible, other treatments should be considered so that corticosteroids are used as little as possible in CSU to reduce the risk of side effects and the burden on health care resources. Keywords: Adverse events; Chronic spontaneous urticaria; Corticosteroid; Health care resource utilization; Treatment patterns Key Summary Points Why carry out this study? Despite the frequent use of corticosteroids in patients with chronic spontaneous urticaria (CSU) and the well-documented risks of longterm use, real-world data on corticosteroid usage in CSU are limited. This analysis aimed to explore adverse events (AEs) and health care resource utilization (HCRU) associated with corticosteroid use in a large US patient cohort with CSU. What was learned from the study? The most common AEs occurring after systemic corticosteroid initiation in patients with CSU included hypertension, lipid disorders, and anxiety. Longer duration of corticosteroid use in patients with CSU was associated with higher proportions of patients experiencing acute and chronic AEs and more frequent AErelated HCRU. Corticosteroid-sparing measures should be optimized in the management of CSU to minimize patient risk and burden on health care systems. INTRODUCTION Chronic spontaneous urticaria (CSU) is a disorder characterized by the sudden and unpredictable appearance of itchy wheals, angioedema, or both, which last for > 6 weeks [1]. Although Dermatol Ther (Heidelb) the average duration of CSU is 1–4 years, some patients experience intermittent symptoms that last > 5 years, or even decades [2, 3]. The physical, emotional, and social impact of symptoms has a substantial effect on patients’ quality of life [4, 5]. CSU has an estimated global point prevalence of up to 3% [2]; real-world data have shown prevalence rates of 0.23–0.78% in the USA [6–8]. Global treatment recommendations for CSU are based on severity of symptoms and response to treatment. Second-generation nonsedating H1-antihistamines (sgH1-AHs) are recommended as first-line treatments for CSU; subsequent lines of treatment include s gH1-AHs at higher doses, omalizumab, dupilumab, remibrutinib, and/or cyclosporine. A short course (maximum of 10 days) of systemic (oral or injectable) corticosteroids (...truncated)