Unexpected Risks of Short-Term Steroid Use

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Unexpected Risks of Short-Term Steroid Use

Postby NHE » Sun Apr 23, 2017 7:42 am

What Are the Unexpected Risks of Short-Term Steroid Use?
https://www.peoplespharmacy.com/2017/04 ... eroid-use/

Even short-term steroid use can increase a person's chance of breaking a bone, developing a severe infection or having a bad blood clot.

Corticosteroids such as methylprednisolone or prednisone are powerful anti-inflammatory medications. Doctors frequently prescribe these medications for bronchitis, sinusitis, asthma, allergic reactions and backache. They may also treat a bad case of poison ivy or a flare-up of rheumatoid arthritis with short-term steroid use.

Most doctors are well aware of the dangers of long-term oral steroids. These drugs can increase the risk of diabetes, high blood pressure and osteoporosis. People taking such medications for months or years are more vulnerable to infections and dangerous blood clots. Some patients may develop psychological reactions.

Many prescribers assume that short-term steroid use carries minimal risk. A new study utilizing insurance information on 1.5 million adults found some unexpected complications of oral steroids taken for less than a month. Often, when these drugs are prescribed for a short period of time, patients start with a high dose and taper down over several days or a few weeks. People who were taking inhaled steroids for asthma, COPD or allergies were not included in the data analysis for this study.

People who took these medications even short term were more likely to break a bone, develop a blood clot or come down with a serious infection (sepsis). These risks started immediately and lasted for at least three months. Such data suggest that everyone should become aware of the potential side effects of medications like prednisone.


Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study
Free full text. http://www.bmj.com/content/bmj/357/bmj.j1415.full.pdf

    Objective: To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use.

    Design: Retrospective cohort study and self controlled case series.Setting Nationwide dataset of private insurance claims.

    Participants: Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014.

    Main outcome measures: Rates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation.

    Results: Of 1,548,945 adults, 327,452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001).

    Conclusion: One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events.
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