Common Steroid Drugs Associated With Uncommon Risks

Steroid pills are commonly being used by millions of people around the world to ease a backache or a nagging cough or allergy symptoms. However, the potential side effects of the medicines that may result in a blood clot, fracture or life-threatening sepsis are unnoticed, finds a new study from the University of Michigan.

The dangerous side effects were compared with adults who did not use corticosteroids.

The research study was reported in the British Medical Journal (BMJ).

Research Study
The research study was conducted by collecting data from 1.5 million non-elderly American adults with private insurance. One out of five people filled a short-term prescription for oral corticosteroids like prednisone.

The rates of the serious events were higher in the first 30 days after a prescription. These levels were elevated even after three months.

The research team also called for better education of prescribers and public on the potential risks and the most appropriate uses and doses for short-term use of steroids.

Advertisement

The United States Food and Drug Administration has also required drug makers to list the side effects of prednisone and other corticosteroids. However, the rate of these events is not well characterized.

Akbar Waljee, M.D., M.Sc., said, "Although physicians focus on the long-term consequences of steroids, they don't tend to think about potential risks from short-term use."

Advertisement

"We see a clear signal of higher rates of these three serious events within 30 days of filling a prescription. We need to understand that steroids do have a real risk and that we may use them more than we really need to. This is so important because of how often these drugs are used."

Short-term Steroids
Oral steroids are often given to patients who have back pain, allergies or respiratory tract infections including bronchitis.

Around half of them received a six-day prepackaged methylprednisolone that tapers the dose of steroids from highest to lowest.

The prepackaged form may cost several times more than that which started at a relatively high dose that is not required always.

Short-term steroids were more likely to be used by older people under the age of 65, white, female and who have multiple health conditions.

The research team excluded people who took steroids before the study period began, anyone who inhaled or injected steroids during the study years and anyone who took steroids for more than 30 days or people who had cancer or transplants.

Study Findings
While comparing the short-term steroid users with non-steroid users, three serious issues were compared in the 5 to 90 days after the clinic visit to when the steroid prescription was filled or routine clinic for non-steroid users. This is what considered as an absolute risk.

• 0.05% of people who took steroids were admitted to a hospital with a diagnosis of sepsis when compared to 0.02% of nonsteroid users.
• 0.14% had clots when compared to 0.09% of nonsteroid users.
• 0.51% had fractures when compared to 0.39% people who did not take corticosteroids.

However, the details did not give account for individual differences between steroid users and non-users.

The rate of three complications among short-term steroid users before and after therapy.

• Sepsis rates were found to be five times higher in the 30 days after steroid prescription.
• Venous thromboembolism (VTE) rates were more than three times as high.
• Fracture rates were twice as high as those who did not take steroid drugs.

Finally, scientists compared the steroid users with a sample of non-steroid users who had similar respiratory conditions. All three health rates were still higher.

The quantities were expressed in incidence rate ratio; steroid users had five times the rate of sepsis, three times the rate of VTE clots and two times the rate of fracture.

Further research may help to know the potential side effects of the drugs once they are released in the market.

Waljee said, "When we have a medication that's being given to a large population, we can pick up signals that might inform us of some potentially harmful side effects that we might otherwise miss in smaller studies."

"Analyzing large data sets like this is a goal of groups like MiCHAMP and can help us see these trends sooner, highlighting the importance of this type of research on Big Data."

The author also concludes that patients and prescribers may use the smallest amount of corticosteroids being used on the condition that is being treated.

"If there are alternatives to steroids, we should be using those when possible."

"Steroids may work faster, but they aren't as risk-free as you might think."

Corticosteroid Drugs
Steroid drugs are man-made versions of hormones produced by the adrenal glands. The drugs may reduce redness and swelling(inflammation).

Corticosteroid drugs act by mimicking the hormones produced by the body to reduce inflammation. This may also induce changes in patients who are at an additional risk of serious events.

Examples include prednisolone, budesonide, cortisone, dexamethasone, hydrocortisone

References

1. Akbar K Waljee, Mary A M Rogers, Paul Lin, Amit G Singal, Joshua D Stein, Rory M Marks, John Z Ayanian, Brahmajee K Nallamothu. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ, 2017; j1415 DOI: 10.1136/bmj.j1415

1. Corticosteroid (Oral Route, Parenteral Route) - (http://www.mayoclinic.org/drugs-supplements/corticosteroid-oral-route-parenteral-route/description/drg-20070491)

Source-Medindia