Serious Adverse Events Linked to Short-Term Corticosteroid Use
A study published in The BMJ reports that based on a study period of three years, one in five American adults were prescribed a short-term course of oral corticosteroids, and the use of these medications was associated with increased risk of serious adverse events.
Researchers from University of Michigan Medical School conducted a retrospective cohort study and self-controlled case series to assess the frequency of prescriptions for short-term oral corticosteroids and the associated adverse events (eg, sepsis, venous thromboembolism [VTE], fractures).
Using a nationwide dataset of private insurance claims, researchers identified patients aged 18–64 years who were enrolled from 2012–2014. The main outcomes included rates of short-term use of oral corticosteroids (defined as <30 days duration), rates of adverse events in corticosteroid users vs. non-users, and the rate ratios for adverse events within 30 day vs. 31–90 day risk periods after treatment initiation.
About 21% (327,452 of 1,548,945) of adults were given at least one outpatient prescription for short-term use of oral corticosteroids over the study period. Older patients, women, and Caucasians demonstrated more frequent use "with significant regional variation (all P<0.001)."
The data revealed the most common indications for short-term corticosteroid use to be upper respiratory tract infections, spinal conditions, and allergies.
There was a higher rate of sepsis (incidence rate ratio [IRR] 5.30, 95% CI: 3.80–7.41), VTE (IRR 3.33, 95% CI: 2.78–3.99), and fracture (IRR 1.87, 95% CI: 1.69–2.07) within 30 days of starting treatment. These incidence rates decreased over the following 31–90 days. The increased risk, however, was sustained at prednisone equivalent doses <20mg/day (IRR 4.02 for sepsis, 3.61 for VTE, and 1.83 for fracture; all P<0.001).
Akbar Waljee, MD, MSC, lead author of the study added, "Although physicians focus on the long-term consequences of steroids, they don't tend to think about potential risks from short-term use."
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