Are oral corticosteroid bursts linked to adverse events?
Oral corticosteroids are commonly prescribed, but long-term use can lead to certain adverse outcomes. A new study takes a look at whether using a corticosteroid burst could mitigate those risks.
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
Fluoxetine helps refractory nocturnal enuresis but not for long
March 29th 2023A 12-week study in Egypt of the efficacy of fluoxetine (a selective serotonin reuptake inhibitor) in children with treatment-refractory nocturnal enuresis (NE) found that though the treatment achieved a good initial response, it was not sustainable.
Meet the Board: Vivian P. Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI
May 20th 2022Contemporary Pediatrics sat down with one of our newest editorial advisory board members: Vivian P. Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI to discuss what led to her career in medicine and what she thinks the future holds for pediatrics.
Are some patients predisposed to avascular necrosis after hip surgery?
March 14th 2023Although avascular necrosis (AVN) is believed to be an iatrogenic complication following treatment of developmental dysplasia of the hip, an investigation in China found 2 characteristics associated with the condition: the likelihood of AVN increases with both the grade of dislocation and of underdevelopment of the ossific nucleus.
Meet the board: Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN
April 22nd 2022In the latest episode of our podcast series, Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN shares why she got into medicine, the myths of pediatric, and what the future may hold for the specialty.
