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Adverse events common with low- to medium-dose glucocorticoids

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients receiving glucocorticoids for inflammatory diseases, adverse events are very common, even at low to medium doses, according to a meta-analysis by researchers in the Netherlands.

In fact, they report in the December Annals of the Rheumatic Diseases, the overall adverse event rate was 150 per 100 patient-years. In studies that focused only on patients with inflammatory bowel disease, the adverse event rate was 555 per 100 patient-years.

When lead author Dr. J. N. Hoes and associates at the University Medical Center Utrecht applied their selection criteria in their literature search, they identified 28 studies involving 2382 subjects, including patients with rheumatoid arthritis (RA, n=796), polymyalgia rheumatica (PMR, n=167), and inflammatory bowel diseases (IBD, n = 1419). All patients had received either low-dose (0 to 7.5 mg prednisolone equivalent per day) or medium-dose (> 7.5 to 30 mg) regimens.

Mean daily doses were 7.5 mg in the RA group, 8.6 mg in the PMR group, and 13.9 mg in the IBD group.

Among the patients with RA and PMR, adverse event rates per 100 patient-years — 43 and 80, respectively — were much lower than in the IBD group.

Adverse events in RA patients consisted primarily of psychological and behavioral disturbances, followed by dermatological and cardiovascular effects. PMR was primarily associated with gastrointestinal, endocrine and metabolic, cardiovascular and infectious events. IBD patients most often reported gastrointestinal and neurological events.

Dr. Hoes and associates note that