The Downsides of Short-Term Corticosteroids

Summary and Comment |
May 2, 2017

The Downsides of Short-Term Corticosteroids

  1. Paul S. Mueller, MD, MPH, FACP

Oral use for <30 days was associated with excess risk for sepsis, venous thromboembolism, and fracture.

  1. Paul S. Mueller, MD, MPH, FACP

Although the adverse effects of long-term corticosteroids are clear, relatively little is known about short-term use. In this retrospective U.S. study, researchers used a nationwide commercial insurance claims dataset to determine the incidence of three adverse effects (sepsis, venous thromboembolism, and fracture) associated with oral corticosteroid use for <30 days by >1.5 million adults (age range, 18–64; mean age, 45) continuously enrolled from 2012 through 2014.

In all, 21% of participants received at least one short-term prescription for an oral corticosteroid (median duration, 6 days; median prednisone equivalent dose, 20 mg daily). Nearly half (47%) of patients received a 6-day “dosepack” of methylprednisolone. Respiratory tract infections and disorders, spinal conditions, and allergies accounted for 56% of prescriptions. In users compared with nonusers, incidence rates for sepsis (1.8 vs. 1.0 per 1000 person-years), venous thromboembolism (VTE; 4.6 vs. 2.4), and fracture (21.4 vs. 14.3) were significantly higher regardless of age. In a self-controlled case series, risks for sepsis (incidence rate ratio, 5.3), VTE (IRR, 3.3), and fracture (IRR, 1.9) were significantly higher during the 5 to 30 days after the prescription date than the 5 to 180 days before the prescription date.

Comment

An astonishing one in five commercially insured adults received a short course of oral corticosteroid therapy during this 3-year study period. Although the absolute excess risk for sepsis, VTE, and fracture associated with short-term corticosteroid use was low, the cumulative number of affected people was not trivial; widespread use of short-term oral corticosteroids thus has substantial public health implications. Clinicians should not administer short-term oral corticosteroids for conditions in which such agents are ineffective. For conditions in which corticosteroids might provide transient symptom relief but are not essential, clinicians should think twice before prescribing these drugs.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)

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