Are oral corticosteroid bursts linked to adverse events?

Oral corticosteroids are a common treatment for inflammatory bowel disease and asthma. However, long-term use has been associated with a number of adverse outcomes, such as infections, glaucoma and hyperglycaemia. To avoid those outcomes, some clinicians have started using them in corticosteroid bursts, which is defined as using them for 14 days or less. A study in JAMA Pediatrics looks for other possible harm from such outbreaks

Researchers used data from the National Health Insurance Research Database in Taiwan from January 2013 and December 2017. They included patients 18 years of age and under. The incidence rates for 4 types of serious adverse reactions: gastrointestinal haemorrhage, sepsis, pneumonia, and glaucoma were calculated for both patients who received and did not receive corticosteroid bursts.

The study enrolled a total of 4,542,623 children, 23% of whom had received a single corticosteroid burst. The most common reasons for prescribing a single burst of corticosteroid were allergic conditions and acute respiratory infections. The differences in incidence rate per 1000 person-years between children who received a single corticosteroid burst and those who did not were 9.35 (95% CI, 9.19-9.51) for pneumonia, 0.01 (95% CI, 0.01-0.03), 0.60 (95% CI, 9.19-9.51) for pneumonia, 0.01 (95% CI, 0.01-0.03), 0.60 (95 % CI, 9.19-9.51)% CI 0.55-0.64) for gastrointestinal bleeding and 0.03 (95% CI 0.02-0.05) for sepsis. The incidence ratios (IRRs) within 5 to 30 days after the burst were 2.19 (95% CI, 2.13-2.25) for pneumonia, 0.98 (95% CI, 0.85-1.13) for glaucoma, 2.02 (95% CI, 1.55-264) for sepsis and 1.41 (95% CI, 1.27-1.57) for gastrointestinal bleeding. In the 31 to 90 days post-dose, the IRRs were 1.08 (95% CI, 0.88-1.32) for sepsis, 1.09 (95% CI, 1.07-1.11) for pneumonia, 1 , 10 (95% CI, 1.02-1.19) for gastrointestinal bleeding, and 0.95 (95% CI, 0.85-1.06) for glaucoma.

The researchers concluded that corticosteroid bursts are associated with a 1.4 to 2.2 times higher risk of sepsis, pneumonia and gastrointestinal bleeding in the first month after starting corticosteroids. However, this increased risk is reduced in the subsequent 31 to 90 days. When considering the use of bursts of oral corticosteroids, clinicians should consider the risks.

Reference

1. Yao T, Wang J, Chang S, et al. Association of oral corticosteroid eruptions with serious side effects in children. JAMA Pediatr. Apr 19, 2021. Epub ahead of print. doi: 10.1001 / jamapediatrics.2021.0433

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