Clinical Question: What is the frequency of short-term corticosteroid prescriptions and adverse events associated with their use?
Background: Long-term corticosteroid use is usually plagued by complications (ie weight gain, glucose intolerance/diabetes, adrenal suppression, hypertension, skin changes etc), therefore is avoided when possible. Less is known about the risk and frequency of short-term steroid use.
Study Design: Retrospective cohort study and self-controlled case series.
Setting: National U.S. dataset of private insurance claims.
Data from 1,548,945 adults (aged 18-64 years) showed that 21.1% of adults received a prescription for short-term corticosteroids. Within 30 days of filling corticosteroids, incident rate ratios (IRR) were increased for sepsis (5.3; 95% confidence interval, 3.8-7.4), venous thromboembolism (3.3; 95% CI, 2.78-3.99), and fracture (1.87; 95% CI, 1.69-2.07).
Short-term corticosteroids were frequently prescribed for indications with little evidence of benefit, such as upper respiratory conditions, spinal conditions, and allergies. For these conditions, patients should be educated about the risks of short-term corticosteroid use and alternative treatments should be considered. This study only evaluated for these three adverse reactions and excluded the elderly, so these findings likely underestimate the adverse effects of short-term corticosteroids.
Bottom Line: Corticosteroids are much of the time recommended for short courses and were related with higher rates of sepsis, venous thromboembolism, and fracture.
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