Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis

Abstract

The risk of adverse events depends on study design and disease. Studies on inflammatory bowel disease were often of short duration with frequent documentation of adverse events which resulted in higher adverse event rates whereas, in studies of rheumatoid arthritis, the longer follow-up may have resulted in lower adverse event rates. In most studies aimed at efficacy of glucocorticoids or other drugs, adverse events were not systematically assessed. Clear guidelines on assessment of adverse events are lacking.

The Prediction and Monitoring of Toxicity Associated with Long-Term Systemic Glucocorticoid Therapy

“…In contrast, patients receiving high-dose GCs appear more likely to experience neuropsychiatric symptoms, although confounding by indication limits interpretation of existing data. In a metaanalysis, psychosis and mood swings were the most common GC-related AE (20 %) in RA, PMR and inflammatory bowel disease patients [ 92 ]. The data, however, are plagued by inconsistency in defining and assessing neuropsychiatric AEs, and the severity of the reported neuropsychiatric AE is often unclear [ 43 -45 ].…”

Management of Rheumatoid Arthritis: Consensus Recommendations From the Turkish League Against Rheumatism

“…The annual incidence reached much higher values in highdose GC therapies, such as 555/100 (95% CI: 391-718) in inflammatory bowel disease. [63] In accordance with these findings, the expert committee has agreed that GCs should be used in low doses.…”

Infecciones en pacientes reumatológicos asociadas a corticosteroides y antagonistas del factor de necrosis tumoral α

“…El riesgo de infecciones oportunistas en pacientes con corticosteroides por vía inhalatoria es muy bajo y en forma localizada. Para pacientes con dosis equivalentes hasta 30 mg al día de prednisona, se estima que el riesgo de infecciones varía entre 9 y 58 eventos cada 100 pacientes año, siendo mayor en el grupo con enfermedad inflamatoria intestinal que en pacientes con polimialgia reumática o artritis reumatoide 5 . Esta dosis umbral puede ser algo menor (~10 mg/día) cuando concurren otros fármacos inmunosupresoras o co-morbilidades como por ejemplo diabetes mellitus y, por otra parte, pueden ser mayores para ciertos agentes como citomegalovirus o raras de observar en pacientes que sólo tienen enfermedad pulmonar obstructiva crónica.…”