Are oral corticosteroid bursts linked to adverse events?

Oral corticosteroids are a common treatment for inflammatory bowel disease and asthma. However, long-term use of them has been linked to a number of adverse outcomes such as infections, glaucoma, and hyperglycemia. To avoid those outcomes, some clinicians have started using them in corticosteroid bursts, which is defined as using them for 14 days or fewer. A study in JAMA Pediatrics looks at whether there are other potential harms because of such bursts.¹

Investigators used data from the National Health Insurance Research Database in Taiwan from January 2013 and December 2017. They included patients aged 18 years and younger. Incidence rates for 4 types of severe adverse events: gastrointestinal bleeding, sepsis, pneumonia, and glaucoma were calculated for both patients who received and did not receive corticosteroid bursts.

A total of 4,542,623 children were included in the study of which 23% had been prescribed a single corticosteroid bursts. The most common reasons for being prescribed a single corticosteroid burst were allergic diseases and acute respiratory tract infections. The incidence rate differences per 1000 person-years between children who received a single corticosteroid burst and those who did not were 9.35 (95% CI, 9.19-9.51) for pneumonia, 0.01 (95% CI, 0.01-0.03), 0.60 (95% CI, 0.55-0.64) for gastrointestinal bleeding, and 0.03 (95% CI, 0.02-0.05) for sepsis. The incidence rate ratios (IRRs) within 5 to 30 days after the burst were 2.19 (95% CI, 2.13-2.25) for pneumonia, 0.98 (95% CI, 0.85-1.13) for glaucoma, 2.02 (95% CI, 1.55-2.64) for sepsis, and 1.41 (95% CI, 1.27-1.57) for gastrointestinal bleeding. In the 31 to 90 days after administration, the IRRs were 1.08 (95% CI, 0.88-1.32) for sepsis, 1.09 (95% CI, 1.07-1.11) for pneumonia, 1.10 (95% CI, 1.02-1.19) for gastrointestinal bleeding, and 0.95 (95% CI, 0.85-1.06) for glaucoma.

The investigators concluded that corticosteroid bursts are linked to a 1.4-to 2.2-fold increased risk of sepsis, pneumonia, and gastrointestinal bleeding in the first month after starting corticosteroid. However, this increased risk is lessened in the subsequent 31 to 90 days. When considering using oral corticosteroid bursts, clinicians should consider the risks.

Reference

1. Yao T, Wang J, Chang S, et al. Association of oral corticosteroid bursts with severe adverse events in children. JAMA Pediatr. April 19, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.0433