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

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Ann Rheum Dis. Published Online First: 6

August 2008. doi:10.1136/ard.2008.092163

Copyright © 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

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Extended Report

Dose-related patterns of glucocorticoid-induced side effects

Dörte Huscher 1*, Katja Thiele 1, Gromnica-Ihle 2, Gert Hein 3,

Winfried Demary 4, Reiner Dreher 5, Zink 1 and Buttgereit

6

1 German Rheumatism Research Centre, Germany

2 private practice, Berlin, Germany

3 Friedrich-Schiller-University Jena, Germany

4 private practice, Hildesheim, Germany

5 private practice, Bad Kreuznach, Germany

6 Dept of Rheumatology & Immunology, Germany

Abstract

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.

http://ard.bmj.com/cgi/content/abstract/ard.2008.092163v1?papetoc

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