By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University

Dr. Deresinski reports no financial relationships relevant to this field of study.

SYNOPSIS: Short-term (< 14 days) administration of oral corticosteroids is associated with an increased risk of adverse events, including an approximately two-fold risk of sepsis.

SOURCE: Yao TC, Huang YW, Chang SM, et al. Association between oral corticosteroid bursts and severe adverse events: A nationwide population-based cohort study. Ann Intern Med 2020;173:325-330.

Investigators in Taiwan examined claims from their country’s National Health Insurance Research Database to examine the relationship between administration of “bursts” of oral corticosteroid and associated adverse events. A burst was defined as administration for < 14 days. The study covered three years ending Dec. 31, 2015.

During that time, 2,623,327 (16.5%) of 15,859,129 individuals received such bursts and met selection criteria, although overall, 25% had received glucocorticoid bursts. Most bursts were administered to treat dermatologic conditions (24.1% of top 10 diagnoses) or upper respiratory tract infections (33.6%). The incidence rates per 1,000 patient-years for gastrointestinal (GI) bleeding and heart failure were 27.1 and 1.3, respectively, while for sepsis it was 1.5 (95% confidence interval [CI], 1.4-1.6). The incidence rate ratios were 1.80 for GI bleeding, 2.37 for heart failure, and 1.99 (95% CI, 2.13-2.63) for sepsis during the five- to 30-day period after steroid administration, but subsequently diminished.

COMMENTARY

Approximately 8% of Taiwanese adults receive a glucocorticoid burst prescription each year. The incidence of short-term (< 30 days) glucocorticoid prescriptions for adults in the United States is approximately 7%, with upper respiratory tract infections the most frequent reason.1

Several years ago, a physician spontaneously told me he routinely gave his children corticosteroids when they developed symptoms of upper respiratory infection, and I was astounded. In fact, it appears this may be a common phenomenon and one that apparently has been promoted. In 2017, an expert panel made a weak recommendation for administration of a single dose of glucocorticoid in the management of patients with sore throats, reasoning that it shortens the duration of symptoms by approximately one day and is unlikely to cause harm.2

Whether a single dose may cause harm is unknown, but it would appear to be a possibility. The study reviewed here indicates that steroid bursts lasting
< 14 days are associated with 1.8- to 2.4-fold increased risk of GI bleeding, heart failure, or sepsis — with, for our specific interests, a two-fold risk of sepsis. Clinicians should carefully consider the potential adverse effects of their prescriptions for short-term use of oral corticosteroids.

REFERENCES

  1. Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: Population based cohort study. BMJ 2017;357:j1415.
  2. Aertgeerts B, Agoritsas T, Siemieniuk RAC, et al. Corticosteroids for sore throat: A clinical practice guideline. BMJ 2017;358:j4090.