TABLE 1

Summary of results from included studies by oral corticosteroid (OCS) dose

First author, year [ref.]High
OCS
A
Medium OCS
B
Low
OCS
C
No
OCS
D
Side-effectComparisonOR (95% CI)p-valueComment
Bone and muscle complications
 Dalal, 2016 [23]12 69712 697Bone, muscleA versus D2.42 (2.29–2.55)Sig.The category muscle and bone includes avascular necrosis, muscle weakness, osteoporosis, back pain and fractures
B versus D2.28 (2.16–2.40)Sig.
C versus D1.36 (1.16–1.59)Sig.
 Lefebvre, 2015 [24]16301630368Bone, muscleA versus C1.59 (1.29–1.96)Sig.The category muscle and bone includes avascular necrosis, muscle weakness, osteoporosis, back pain and fractures
B versus C1.51 (1.25–1.82)Sig.
 Lefebvre, 2017 [22]1630163036826 987Bone, muscleA versus D1.89 (1.68–2.12)Sig.The category muscle and bone includes avascular necrosis, muscle weakness, osteoporosis, back pain and fractures
B versus D1.72 (1.55–1.92)Sig.
C versus D1.09 (0.94–1.26)ns
 Daugherty, 2018 [25]35 42424 994OsteoporosisA versus D12.61# (10.45–15.21)<0.0001
B versus D6.79# (5.98–7.73)<0.0001
C versus D1.64# (1.51–1.78)<0.0001
 Zazzali, 2015 [26]36043604OsteoporosisA versus D1.83 (1.50–2.25)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
FracturesA versus D1.50 (1.11–2.04)0.0099
 Zeiger, 2017 [27]7828764OsteoporosisA versus C1.73 (1.21–2.41)0.0035The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
FracturesA versus C 1.63 (1.22–2.14)0.0015
Adrenal complications
 Dalal, 2016 [23]12 69712 697Adrenal complicationsA versus D40.67 (15.12–109.35)Sig.The category adrenal includes Cushing's syndrome
B versus D20.95 (7.62–57.63)Sig.
C versus D3.87 (0.93–16.06)ns
 Zeiger, 2017 [27]7828764Poisoning by adrenal corticosteroidsA versus C12.38 (5.36–28.86)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
Cardiovascular system
 Dalal, 2016 [23]12 69712 697CardiovascularA versus D1.73 (1.57–1.90)Sig.The category cardiovascular includes atrial fibrillation, flutter, hypertension, and myocardial infarction
B versus D1.77 (1.62–1.93)Sig.
C versus D1.21 (0.90–1.62)ns
 Lefebvre, 2015 [24]16301630368CardiovascularA versus C1.96 (1.48–2.58)Sig.The category cardiovascular includes atrial fibrillation, flutter, hypertension, and myocardial infarction
B versus C2.12 (1.63–2.76)Sig.
 Lefebvre, 2017 [22]1630163036826 987CardiovascularA versus D2.06 (1.76–2.41)Sig.The category cardiovascular includes atrial fibrillation, flutter, hypertension, and myocardial infarction
B versus D2.23 (1.93–2.59)Sig.
C versus D1.14 (0.87–1.48)ns
 Daugherty, 2018 [25]35 42424 994Myocardial infarctionA versus D2.15# (1.67–2.77)<0.0001
B+C versus D1.25# (1.09–1.43)0.0012
StrokeA-C versus D1.11# (0.97–1.27)0.1253
 Zazzali, 2015 [26]36043604HypertensionA versus D1.29 (1.17–1.42)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
 Zeiger, 2017 [27]7828764HypertensionA versus C1.49 (1.28–1.73)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
Metabolic complications
 Dalal, 2016 [23]12 69712 697MetabolicA versus D1.35 (1.25–1.45)Sig.The category other includes hyperglycaemia, dyslipidaemia, obesity, diabetes mellitus and metabolic syndrome
B versus D1.32 (1.23–1.41)Sig.
C versus D0.87 (0.72–1.07)ns
 Lefebvre, 2015 [24]16301630368MetabolicA versus C1.51 (1.23–1.85)Sig.The category other includes hyperglycaemia, dyslipidaemia, obesity, diabetes mellitus and metabolic syndrome
B versus C1.50 (1.25–1.81)Sig.
 Lefebvre, 2017 [22]1630163036826 987MetabolicA versus D1.55 (1.37–1.75)Sig.The category other includes hyperglycaemia, dyslipidaemia, obesity, diabetes mellitus and metabolic syndrome
B versus D1.56 (1.38–1.76)Sig.
C versus D1.17 (0.98–1.40)Sig.
 Zazzali, 2015 [26]36043604Diabetes mellitusA versus D1.30 (1.18–1.44)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
ObesityA versus D1.17 (1.04–1.32)0.0124
Lipid disordersA versus D0.80 (0.73–0.88)<0.0001
 Zeiger, 2017 [27]7828764DiabetesA versus C1.12 (0.89–1.39)0.3403The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
Eye diseases
 Dalal, 2016 [23]12 69712 697OcularA versus D1.19 (1.11–1.28)Sig.The category ocular includes cataracts and glaucoma
B versus D1.09 (1.02–1.17)Sig.
C versus D0.95 (0.84–1.08)ns
 Lefebvre, 2015 [24]16301630368OcularA versus C1.55 (1.32–1.83)Sig.The category ocular includes cataracts and glaucoma
B versus C1.29 (1.09–1.51)Sig.
 Lefebvre, 2017 [22]1630163036826 987OcularA versus D2.02 (1.78–2.29)Sig.The category ocular includes cataracts and glaucoma
B versus D1.63 (1.43–1.87)Sig.
C versus D1.33 (1.14–1.54)Sig.
 Daugherty, 2018 [25]35 42424 994CataractsA versus D3.38# (2.41–4.73)<0.0001
B versus D1.76# (1.52–2.04)<0.0001
C versus D1.07# (1.00–1.15)0.052
 Zazzali, 2015 [26]36043604GlaucomaA versus D1.25 (0.99–1.58)0.0673The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
CataractsA versus D1.29 (1.06–1.57)0.0117
 Zeiger, 2017 [27]7828764GlaucomaA versus C1.38 (0.86–2.12)0.1560The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
CataractsA versus C1.42 (1.02–1.93)0.0417
Psychiatric disorders
 Dalal, 2016 [23]12 69712 697PsychiatricA versus D1.74 (1.62–1.86)Sig.The category psychiatric includes bipolar disorder, depression, sleep disturbances and steroid psychosis
B versus D1.73 (1.62–1.86)Sig.
C versus D1.16 (0.95–1.41)ns
 Lefebvre, 2015 [24]16301630368PsychiatricA versus C1.28 (1.03–1.60)Sig.The category psychiatric includes bipolar disorder, depression, sleep disturbances and steroid psychosis
B versus C1.35 (1.10–1.66)Sig.
 Lefebvre, 2017 [22]1630163036826 987PsychiatricA versus D1.46 (1.28–1.66)Sig.The category psychiatric includes bipolar disorder, depression, sleep disturbances and steroid psychosis
B versus D1.62 (1.42–1.84)Sig.
C versus D1.40 (1.16–1.70)Sig.
 Zeiger, 2017 [27]7828764DepressionA versus C1.07 (0.85–1.32)0.5713The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
AnxietyA versus C1.64 (1.33–2.00)<0.0001
Infections
 Dalal, 2016 [23]12 69712 697InfectionsA versus D2.43 (2.17–2.71)Sig.The category infections includes fungal infections, pneumonia, sepsis, tuberculosis, urinary tract infection, varicella infection and bursitis
B versus D2.25 (2.11–2.40)Sig.
C versus D1.70 (1.34–2.16)Sig.
 Lefebvre, 2015 [24]16301630368InfectionsA versus C1.91 (1.51–2.43)Sig.The category infections includes fungal infections, pneumonia, sepsis, tuberculosis, urinary tract infection, varicella infection and bursitis
B versus C1.72 (1.37–2.16)Sig.
 Lefebvre, 2017 [22]1630163036826 987InfectionsA versus D2.94 (2.61–3.33)Sig.The category infections includes fungal infections, pneumonia, sepsis, tuberculosis, urinary tract infection, varicella infection and bursitis
B versus D2.53 (2.27–2.82)Sig.
C versus D1.56 (1.34–1.81)Sig.
 Zazzali, 2015 [26]36043604Opportunistic infectionsA versus D4.16 (2.34–8.00)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
PneumoniaA versus D3.22 (2.84–3.66)<0.0001
 Zeiger, 2017 [27]7828764InfectionsA versus C1.64 (1.38–1.95)<0.0001The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
Gastrointestinal complications
 Dalal, 2016 [23]12 69712 697GastrointestinalA versus D1.96 (1.84–2.10)Sig.The category gastrointestinal includes nausea, vomiting, gastrointestinal bleeds, ulcers and dyspepsia
B versus D2.02 (1.89–2.15)Sig.
C versus D1.18 (0.98–1.41)ns
 Lefebvre, 2015 [24]16301630368GastrointestinalA versus C1.81 (1.46–2.24)Sig.The category gastrointestinal includes nausea, vomiting, gastrointestinal bleeds, ulcers and dyspepsia
B versus C1.63 (1.34–1.99)Sig.
 Lefebvre, 2017 [22]1630163036826 987GastrointestinalA versus D2.55 (2.28–2.84)Sig.The category gastrointestinal includes nausea, vomiting, gastrointestinal bleeds, ulcers and dyspepsia
B versus D2.31 (2.08–2.56)Sig.
C versus D1.50 (1.28–1.76)Sig.
 Daugherty, 2018 [25]35 42424 994Peptic ulcerA-C versus D1.13# (1.00–1.28)0.0486
 Zazzali, 2015 [26]36043604Peptic ulcerA versus D1.14 (0.40–3.32)1The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
 Zeiger, 2017 [27]7828764Ulcer diseaseA versus C3.62 (1.30–8.66)0.0136The odds ratios, confidence intervals and p-values presented in this review were calculated by the SmartStep Data Institute
Various
 Dalal, 2016 [23]12 69712 697Skin diseaseA versus D1.66 (1.51–1.83)Sig.The category skin disease includes bruising, impaired wound healing, striae and skin thinning
B versus D1.42 (1.28–1.57)Sig.
C versus D1.37 (1.18–1.59)Sig.
OtherA versus D1.82 (1.61–2.05)Sig.The category other includes bladder cancer, epistaxis and non-Hodgkin's lymphoma
B versus D1.77 (1.56–2.00)Sig.
C versus D1.13 (0.88–1.46)ns
 Lefebvre, 2015 [24]16301630368OtherA versus C1.23 (0.95–1.60)nsThe category other includes bladder cancer, epistaxis and non-Hodgkin's lymphoma
B versus C1.36 (1.07–1.73)Sig.
 Lefebvre, 2017 [22]1630163036826 987Haematology/oncologyA versus D1.69 (1.35–2.12)Sig.The category haematology/oncology includes bladder cancer, epistaxis and non-Hodgkin's lymphoma
B versus D1.96 (1.59–2.41)Sig.
C versus D1.58 (1.24–2.01)Sig.

Data are presented as n, unless otherwise stated. OCS: oral corticosteroids; sig.: significant; ns: nonsignificant. #: hazard ratio (95% CI).