Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1415 (Published 12 April 2017)Cite this as: BMJ 2017;357:j1415
Cohort study of more than 1.5 million adults 30 days of initiating these drugs, even at relatively low doses, users had:
- a nearly 2x increased risk for fracture
- 3x risk for VTE and
- 5xrisk for sepsis
- > one in five adults included in the Clinformatics DataMart, a large national database of commercial insurance claims, received prescriptions for short-term oral corticosteroids during the 3-year study, which ran from January 1, 2012, to December 31, 2014.
- Of 1,548,945 adults aged 18 to 64 years included in the database, 327,452 (21.1%) received at least one outpatient prescription for short-term oral corticosteroids (30 or fewer days). The mean age of users was 45.5 years (standard deviation [SD], 11.6 years) compared with 44.1 years (SD, 12.2 years) for nonusers (P < .001). The median duration of use was 6 days (interquartile range, 6 – 12 days).
- The six most common indications for the drugs were upper respiratory tract infections, spinal conditions, intervertebral disc disorders, allergies, bronchitis, and nonbronchitic lower respiratory tract disorders.
- Within 30 days of drug initiation, there was an increase in incidence rate of the following: sepsis, with a rate ratio of 5.30 (95% CI, 3.80 – 7.41); venous thromboembolism, with a rate ratio of 3.33 (95% CI, 2.78 – 3.99); and fracture, with a rate ratio of 1.87 (95% CI, 1.69 – 2.07).
- Rate ratios decreased during the following subsequent 31 to 90 days, however.
- Recommendation: prescribing the smallest possible amount of corticosteroids for treating the condition in question. “If there are alternatives to steroids, we should be use those when possible,”