Drug Safety

, Volume 41, Issue 7, pp 725–730 | Cite as

Glucocorticoids and the Risk of Peptic Ulcer Bleeding: Case–Control Analysis Based on Swiss Claims Data

  • Daphne Reinau
  • Matthias Schwenkglenks
  • Mathias Früh
  • Andri Signorell
  • Eva Blozik
  • Christoph R. Meier
Original Research Article



Controversy exists as to whether glucocorticoids (GC) are ulcerogenic per se and may thus cause peptic ulcer bleeding (PUB) independent of concomitantly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs).


To investigate the association between GC use and PUB with or without co-medication with NSAIDs.


We conducted a case–control study using administrative claims data from the Swiss health insurance company Helsana. We identified 1191 cases with incident PUB between 2012 and 2016 and matched up to 10 PUB-free controls to each case on age, sex, region and number of years insured with Helsana. We compared prior GC exposure between cases and controls using multivariate conditional logistic regression analyses controlling for several potential confounders. Patients with or without concomitant NSAID exposure were analysed separately.


Patients with prior exposure to both GC and NSAIDs were five times more likely to experience PUB than patients who neither used GC nor NSAIDs (adjusted odds ratio [adj. OR] 4.80, 95% CI 3.55–6.71). Although the risk of PUB among patients who used NSAIDs without GC was increased threefold (adj. OR 3.20, 95% CI 2.59–3.95), we observed only a moderately increased risk among patients who used GC alone without NSAIDs (adj. OR 1.63, 95% CI 1.20–2.42).


The use of NSAIDs with or without GC was associated with a markedly higher risk of PUB compared with GC monotherapy. Use of GC alone was associated with a moderately increased risk of PUB, which might be causal or attributed to confounding by indication.


Compliance with Ethical Standards


The study was funded by Helsana Group, Zurich, Switzerland.

Conflict of interest

Daphne Reinau, Matthias Schwenkglenks, Mathias Früh, Andri Signorell, Eva Blozik and Christoph R. Meier have no conflicts of interest directly relevant to the content of this study.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Daphne Reinau
    • 1
    • 2
  • Matthias Schwenkglenks
    • 3
  • Mathias Früh
    • 4
  • Andri Signorell
    • 4
  • Eva Blozik
    • 4
  • Christoph R. Meier
    • 1
    • 2
    • 5
  1. 1.Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
  2. 2.Hospital PharmacyUniversity Hospital BaselBaselSwitzerland
  3. 3.Institute of Pharmaceutical Medicine (ECPM)University of BaselBaselSwitzerland
  4. 4.Department of Health SciencesHelsana GroupZurichSwitzerland
  5. 5.Boston Collaborative Drug Surveillance ProgramLexingtonUSA

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