RESEARCH - Population-based assessment of adverse events associated with long-term steroid use

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Arthritis Care & Research

Volume 55, Issue 3, Pages 420-426

Published Online: 31 May 2006

Population-based assessment of adverse events associated with

long-term glucocorticoid use

R. Curtis 1, O. Westfall 1, Jeroan 1, Johannes

W. Bijlsma 2, Freeman 3, Varghese 1, Stacey H. Kovac 4,

M. Spettell 3, G. Saag 1 *

1University of Alabama at Birmingham

2University Medical Center, Utrecht, The Netherlands

3Aetna Integrated Informatics, Aetna, Inc., Blue Bell, Pennsylvania

4Durham VA Medical Center, and Duke University, Durham, North Carolina

Abstract

Objective

The frequency of many adverse events (AEs) associated with low-dose

glucocorticoid use is unclear. We sought to determine the prevalence

of glucocorticoid-associated AEs in a large US managed care

population.

Methods

Using linked administrative and pharmacy claims, adults receiving 60

days of glucocorticoids were identified. These individuals were

surveyed about glucocorticoid use and symptoms of 8 AEs commonly

attributed to glucocorticoid use.

Results

Of the 6,517 eligible glucocorticoid users identified, 2,446 (38%)

returned the mailed survey. Respondents were 29% men with a mean ± SD

age of 53 ± 14 years; 79% were white and 13% were African American.

Respondents had a mean ± SD of 7 ± 3 comorbid conditions and were

prescribed a mean ± SD prednisone-equivalent dosage of 16 ± 14 mg/day.

More than 90% of individuals reported at least 1 AE associated with

glucocorticoid use; 55% reported that at least 1 AE was very

bothersome. Weight gain was the most common self-reported AE (70% of

the individuals), cataracts (15%) and fractures (12%) were among the

most serious. After multivariable adjustment, all AEs demonstrated a

strong dose-dependent association with cumulative glucocorticoid use.

Among users of low-dose therapy (7.5 mg of prednisone per day),

increasing duration of use was significantly associated with acne,

skin bruising, weight gain, and cataracts.

Conclusion

The prevalence of 8 commonly attributed self-reported

glucocorticoid-associated AEs was significantly associated with

cumulative and average glucocorticoid dose in a dose-dependent

fashion. Physicians should be vigilant for glucocorticoid-related AEs

and should counsel patients about possible risks, even among low-dose

long-term users.

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http://www3.interscience.wiley.com/cgi-bin/fulltext/112636788/HTMLSTART

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