Recognising the long-term burden of short course oral corticosteroids

Abstract

Introduction: The high adverse effect (AE) burden with systemic and oral corticosteroid (OCS) use is well known, but many HCPs may be unfamiliar with data supporting risk even from low dose single burst and intermittent short course OCS.

Aims: To undertake a literature review to evaluate the evidence for risks associated with intermittent short course OCS use in chronic inflammatory conditions.

Methods: A PubMed search was conducted in December 2020, followed by detailed review, to identify key publications reporting on OCS-related AEs and dosing strategies in inflammatory conditions (no limits; year/type). Low dose OCS use (single burst and intermittent) was captured as systematic reviews, meta-analyses and primary data.

Results: Of 4599 publications found; 58 were considered key. Risks of AEs are high with short course/intermittent OCS. A systematic review (38 studies; including 22 RCTs) showed OCS use for ≤14 days in children was associated with vomiting, behavioural change and sleep disturbance, and infection in 0.9% of cases (including severe needing ICU support). In 24,117 adult pairs matched for first vs no OCS use, a dose-response relationship for cumulative OCS exposure and AEs was seen, with most effects evident at cumulative exposures as low as 0.5–<1 g (~4 lifetime courses) vs >0–<0.5 g. Short term OCS use was cumulatively associated with osteoporosis, hyperglycaemia and muscle weakness, even when given for <7 days.

Conclusions: Short OCS courses carry risk from serious cumulative AEs; the need for an OCS burst to treat, for example, an asthma exacerbation, should trigger review, risk evaluation and consideration of the need to initiate steroid-sparing therapies e.g., biologics.

Funding: GSK