RESEARCH - Dose-related patterns of steroid-induced side effects

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Ann Rheum Dis. 2008 Aug 6.

Dose-related patterns of glucocorticoid-induced side effects.

Huscher D, Thiele K, Gromnica-Ihle E, Hein G, Demary W, Dreher R, Zink

A, Buttgereit F.

German Rheumatism Research Centre, Germany.

OBJECTIVE: To identify patterns of self-reported health problems

relating to dose and duration of GC intake in unselected patients with

rheumatoid arthritis from routine practice.

METHODS: We analyzed data from 1,066 patients. The clinical status and

drug treatment were reported by the physician, health problems during

the past 6 months by the patient using a comprehensive list of

symptoms. Patients with ongoing GC treatment for >6 months and current

doses of <5, 5-7.5 and >7.5 mg/d prednisone equivalent were compared

to a group without any GC treatment for at least 12 months.

RESULTS: The frequency of self-reported health problems was lowest in

the group without GC exposition and increased with dosage. We observed

two distinct dose-related patterns of adverse events: A " linear "

rising with increasing dose was found for cushingoid phenotype,

ecchymosis, leg oedema, mycosis, parchment-like skin, shortness of

breath, and sleep disturbance. A " threshold pattern " describing an

elevated frequency of events beyond a certain threshold value was

observed at dosages of >7.5mg/d for glaucoma, depression/ listlessness

and increase of blood pressure. Dosages of 5 mg/d or more were

associated with epistaxis and weight gain. A very low threshold was

seen for eye cataract (<5 mg/d).

CONCLUSION: The associations found are in agreement with biologic

mechanisms and clinical observations. Since there is a paucity of

real-life data on adverse effects of GCs prescribed to unselected

groups of patients, our data may help the clinician to adapt therapy

with GC accordingly and improve the benefit-risk-ratio.

PMID: 18684744

http://www.ncbi.nlm.nih.gov/pubmed/18684744

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Not an MD