A Closer Look At The Serious Risks Associated With Short-Term Oral Corticosteroid Use
Oral steroids are well known to be associated with numerous potential adverse effects. These include fluid and electrolyte disturbance; gastric irritation and possible peptic ulceration; hypercortisolism and adrenal insufficiency; hyperglycemia and precipitation of diabetes mellitus; hypertension, thromboembolism and congestive heart failure exacerbation; increased intraocular pressure and ocular nerve damage; osteoporosis and avascular necrosis; insomnia and exacerbation of psychiatric disorders; impaired wound healing and skin fragility; and increased susceptibility to infection, as well as masked symptoms of infection.1
Corticosteroids are among the most common medications that lead to hospitalization for adverse events. We previously believed that using short-term, low-dose oral corticosteroid therapy avoided the majority of these adverse effects. However, several recent studies have challenged this belief, showing adverse effects associated with the short-term use of oral corticosteroids.
Sullivan and colleagues recently found that intermittent use of oral corticosteroids in the treatment of asthma had a cumulative burden on increasing the odds of developing adverse effects.2 The authors found this occurred regardless of the dose and duration of oral corticosteroid therapy with even short-term use of steroids increasing the risk of developing adverse effects. The authors recommended steroid-sparing strategies to improve patient outcomes and minimize the incidence of steroid associated adverse effects.
A large population-based cohort study by Waljee and coworkers also recently showed that even short-term courses of oral steroids carry serious risk.3 This study, published in the April 2017 issue of the British Medical Journal, examined a cohort of over 1.5 million adults over a period of three years with 21.1 percent of this population receiving a prescription for outpatient short-term oral corticosteroids. The study defined the short-term use of corticosteroids as 30 days or less. The study found a significant increase in adverse effects even with the short-term use of steroids. Specifically, the short-term use of oral steroids doubled the risk of fracture, tripled the risk for venous thromboembolism and produced a fivefold increase in the risk of sepsis. Nearly half of the prescriptions for short-term steroids in this study were for a six-day methylprednisolone dose pack.
Podiatric physicians commonly use short-term oral corticosteroids for inflammatory conditions including plantar fasciitis, tendinopathies, gouty arthritis and other inflammatory arthropathies. While these medications can provide rapid relief of pain and inflammation, they are not without risk even with short-term use. Given the risks associated with short-term oral corticosteroids, providers should use steroid-sparing strategies to improve patient outcomes and avoid adverse effects. These steroid sparing strategies include using alternatives to oral steroids whenever possible and when it is necessary to prescribe steroids, using the shortest course and lowest possible dose.
References
1. Zoorob RJ, Cender D. A different look at corticosteroids. Am Fam Phys. 1998;58(2):443-450.
2. Sullivan PW, Ghushchyan VH, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthma. J Allergy Clin Immunol. 2017; epub Apr. 26.
3. Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415.
