Millions of times a year, Americans get prescriptions for a week’s worth of steroid pills, hoping to ease a backache or quell a nagging cough or allergy symptoms.
A new study from the University of Michigan suggests that we need to pay more attention to the potential side effects of oral corticosteroids, even for short term use.
People taking the pills were more likely to
- break a bone,
- have a potentially dangerous blood clot
- or suffer a life-threatening bout of sepsis in the months after their treatment,
compared with similar adults who didn’t use short-term steroids…
2017 Study Abstract
Objective
To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use.
Design
Retrospective cohort study and self controlled case series.
Setting
Nationwide dataset of private insurance claims.
Participants
Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014.
Main outcome measures
Rates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation.
Results
Of 1 548 945 adults, 327 452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001).
Conclusion
One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events.
Sources and Press Releases
- Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study, The BMJ, doi.org/10.1136/bmj.j1415, 12 April 2017.
- Common drugs, uncommon risks? Higher rate of serious problems after short-term steroid use, medicalxpress, April 13, 2017.