Steroid-Utilization Patterns and Rationality of Prescribing In a North-Indian Rheumatology Out-Patient Cohort: A Longitudinal Drug-Use Evaluation Study

Abstract

Background: Glucocorticoids remain indispensable in rheumatology, yet their toxicity profile mandates rational use. South-Asian data clarifying real-world utilisation and alignment with World Health Organization (WHO) benchmarks are sparse. Methods: We conducted a hospital-based longitudinal drug-utilisation review (DUR) between February 2023 and April 2024 in the Clinical Immunology & Rheumatology out-patient department of Sawai Man Singh Hospital, Jaipur. Newly diagnosed adults (≥ 18 years) receiving ≥ 1 systemic corticosteroid were enrolled and followed at two subsequent visits (n = 120). Prescriptions were mapped to WHO/INRUD core indicators, India’s Standard Treatment Guidelines (STG-6th Edition) and the 2022 National List of Essential Medicines (NLEM). Adverse-drug reactions (ADRs) were adjudicated by the WHO-UMC scale; adherence was quantified with a modified Hill–Bone questionnaire. Results: A total of 762 medicines (13 classes) were issued (mean ± SD 6.35 ± 2.27 drugs/encounter). Prednisolone constituted 67.5 % of steroid prescriptions; methyl-prednisolone 1.7 %; combination regimens 30.8 %. Rheumatoid arthritis (50 %) and systemic lupus erythematosus (10 %) dominated indications. Generic prescribing (77.3 %) and NLEM conformity (75.9 %) were high, whereas injections were employed in 32.5 % of encounters. Seven probable ADRs (5.8 %) were recorded. Adherence improved from 44.2 % to 53.3 % across visits (p = 0.04). Overall, 72 % of steroid courses complied fully with STG-6th Edition tapering algorithms. Conclusion: In this tertiary rheumatology clinic, oral prednisolone is largely prescribed generically and from the essential-drugs list, achieving acceptable rational-use metrics. Persisting polypharmacy and injectable overuse warrant stewardship. Embedding routine pharmacovigilance and adherence support may further optimise benefit-risk.