Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis
Abstract
Objectives To systematically analyse the literature on reported adverse events of low- to medium-dose glucocorticoids during >or=1 month for inflammatory diseases.Methods Data were systematically retrieved and selected from PUBMED, EMBASE and CINAHL databases (6097 hits).Results A total of 28 studies (2382 patients) met the inclusion criteria. The risk of adverse events over all studies was 150 per 100 patient-years (95% confidence interval (CI) 132 to 169). Psychological and behavioural adverse events (eg, minor mood disturbances) were most frequently reported, followed by gastrointestinal events (eg, dyspepsia, dysphagia). In 14 studies comprising 796 patients with rheumatoid arthritis the risk of adverse events was 43/100 patient-years (95% CI 30 to 55), in 4 studies of 167 patients with polymyalgia rheumatica the risk of adverse events was 80/100 patient-years (95% CI 15 to 146), and in 10 studies of 1419 patients with inflammatory bowel disease the risk of adverse events was 555/100 patient-years (95% CI 391 to 718). High rates of adverse events were reported in high-quality studies with short follow-up, notably in studies of patients with inflammatory bowel disease.Conclusions The risk of adverse events depends on study design and disease. Studies on inflammatory bowel disease were often of short duration with frequent documentation of adverse events which resulted in higher adverse event rates whereas, in studies of rheumatoid arthritis, the longer follow-up may have resulted in lower adverse event rates. In most studies aimed at efficacy of glucocorticoids or other drugs, adverse events were not systematically assessed. Clear guidelines on assessment of adverse events are lacking.
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In clinical trials with chronic use of low-dose GC treatment, incident diabetes is reported less frequently.
“In contrast, in clinical trials with chronic use of low-dose GC treatment, incident diabetes is reported less frequently [16].”
From Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial (2011) · cites this paper as [16]
In prospective studies, the reported incidence of diabetes at lower GC doses has been more modest, although there was considerable variation depending on the patient group exposed.
“In prospective studies, the reported incidence of diabetes at lower GC doses has been more modest, although there was considerable variation depending on the patient group exposed [16].”
From Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial (2011) · cites this paper as [16]
Cites
The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis
Staa, T. P. V., Staa, T. P. V., Staa, T. P. V., Leufkens, H. G. M., & Cooper, C. (2002) · Osteoporosis International · doi:10.1007/s001980200108 · Cited by 1,294 · see citing works
Boers, M., Verhoeven, A. C., Markusse, H. M., van de Laar, M. A., Westhovens, R., van Denderen, J. C., van Zeben, D., Dijkmans, B. A. C., Peeters, A. J., Jacobs, P., et al. (1997) · The Lancet · doi:10.1016/s0140-6736(97)01300-7 · Cited by 1,073 · see citing works
The Effect of Glucocorticoids on Joint Destruction in Rheumatoid Arthritis
Kirwan, J. R. (1995) · New England Journal of Medicine · doi:10.1056/nejm199507203330302 · Cited by 817 · see citing works
Population‐based assessment of adverse events associated with long‐term glucocorticoid use
Curtis, J. R., Westfall, A. O., Allison, J., Bijlsma, J. W., Freeman, A., George, V., Kovac, S. H., Spettell, C. M., & Saag, K. G. (2006) · Arthritis Care & Research · doi:10.1002/art.21984 · Cited by 595 · see citing works
Self-citationButtgereit, F., Da Silva, J. A. P., Boers, M., Burmester, G.-R., Cutolo, M., Jacobs, J., Kirwan, J., Köhler, L., van Riel, P., Vischer, T., et al. (2002) · Annals of the Rheumatic Diseases · doi:10.1136/ard.61.8.718 · Cited by 544 · see citing works
Self-citationda Silva, J. A. P., Jacobs, J. W. G., Kirwan, J., Boers, M., Saag, K. G., Inês, L. B. S., de Koning, E. J. P., Buttgereit, F., Cutolo, M., Capell, H., et al. (2005) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2005.038638 · Cited by 522 · see citing works
Self-citationvan Everdingen, A. A., Jacobs, J. W. G., van Reesema, D. R. S., & Bijlsma, J. W. J. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-1-200201010-00006 · Cited by 488 · see citing works
Self-citationHoes, J. N., Jacobs, J. W. G., Boers, M., Boumpas, D., Buttgereit, F., Caeyers, N., Choy, E., Cutolo, M., da Silva, J. A. P., Esselens, G., et al. (2007) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2007.072157 · Cited by 410 · see citing works
Self-citationSvensson, B., Boonen, A. E. R. C. H., Albertsson, K., et al. (2005) · Arthritis & Rheumatism · doi:10.1002/art.21298 · Cited by 350 · see citing works
Wassenberg, S., Rau, R., Steinfeld, P., Zeidler, H. K., & Low‐Dose Prednisolone Therapy Study Group (2005) · Arthritis & Rheumatism · doi:10.1002/art.21421 · Cited by 308 · see citing works
Campieri, M., Adamo, S., Valpiani, D., D’Arienzo, A., D'Albasio, G., Pitzalis, M. V., Cesari, P., Casetti, T., Castiglione, G. N., Rizzello, F., et al. (2003) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2003.01609.x · Cited by 102 · see citing works
Room for improvement? A survey of the methods used in systematic reviews of adverse effects
Golder, S., Loke, Y. K., & McIntosh, H. M. (2006) · BMC Medical Research Methodology · doi:10.1186/1471-2288-6-3 · Cited by 73 · see citing works
Hawthorne, A. B., Record, C. O., Holdsworth, C. D., Giaffer, M. H., Burke, D., Keech, M. L., & Hawkey, C. J. (1993) · Gut · doi:10.1136/gut.34.1.125 · Cited by 49 · see citing works
A randomised placebo controlled 12 week trial of budesonide and prednisolone in rheumatoid arthritis
Kirwan, J., Hällgren, R., Mielants, H., et al. (2004) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2003.008573 · Cited by 49 · see citing works
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Glucocorticoid-Induced Osteoporosis
Buckley, L., & Humphrey, M. B. (2018) · New England Journal of Medicine · doi:10.1056/nejmcp1800214 · Cited by 438 · see citing works
Bi-directionality of brain–gut interactions in patients with inflammatory bowel disease
Gracie, D. J., Guthrie, E. A., Hamlin, P. J., & Ford, A. C. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.01.027 · Cited by 408 · see citing works
Prevalence of long-term oral glucocorticoid prescriptions in the UK over the past 20 years
Fardet, L., Petersen, I., & Nazareth, I. (2011) · Rheumatology · doi:10.1093/rheumatology/ker017 · Cited by 319 · see citing works
Abu-Sbeih, H., Ali, F. S., Alsaadi, D., Jennings, J., Luo, W., Gong, Z., Richards, D. M., Charabaty, A., & Wang, Y. (2018) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-018-0461-4 · Cited by 215 · see citing works
Abu-Sbeih, H., Ali, F. S., Wang, X., Mallepally, N., Chen, E., Altan, M., Bresalier, R. S., Charabaty, A., Dadu, R., Jazaeri, A., et al. (2019) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-019-0577-1 · Cited by 191 · see citing works
Optimized glucocorticoid therapy: teaching old drugs new tricks
Strehl, C., & Buttgereit, F. (2013) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2013.01.026 · Cited by 118 · see citing works
van Raalte, D. H., Brands, M., van der Zijl, N. J., Muskiet, M. H., Pouwels, P. J. W., Ackermans, M. T., Sauerwein, H. P., Serlie, M. J., & Diamant, M. (2011) · Diabetologia · doi:10.1007/s00125-011-2174-9 · Cited by 109 · see citing works
“In prospective studies, the reported incidence of diabetes at lower GC doses has been more modest, although there was considerable variation depending on the patient group exposed [16].”
BackgroundResultLow‐dose glucocorticoid therapy in rheumatoid arthritis: an obligatory therapy
Bijlsma, J. W. J., van der Goes, M. C., Hoes, J. N., Jacobs, J. W. G., Buttgereit, F., & Kirwan, J. (2010) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2009.05342.x · Cited by 31 · see citing works
Self-citationOu, G., Bressler, B., Galorport, C., Lam, E., Ko, H. H., Enns, R., Telford, J., Schaffer, N., Lee, T., & Rosenfeld, G. (2018) · Journal of the Canadian Association of Gastroenterology · doi:10.1093/jcag/gwy023 · Cited by 28 · see citing works
- Authors
- Hoes, J. N., Jacobs, J. W. G., Verstappen, S. M. M., Bijlsma, J. W. J., & Van der Heijden, G. J. M. G.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Jacobs, J W G
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 68
- Issue
- 12
- Pages
- 1833-1838
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W2122641956
- Cited by
- 243
- References
- 14
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 16 · 2023: 14 · 2022: 13 · 2021: 19 · 2020: 13 · 2019: 15 · 2018: 16 · 2017: 13 · 2016: 14 · 2015: 9 · 2014: 15 · 2013: 19 · 2012: 14
- FWCI
- 8.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- oral corticosteroids, adverse events, low-dose glucocorticoids, inflammatory diseases, rheumatoid arthritis, polymyalgia rheumatica, inflammatory bowel disease, gastrointestinal adverse effects, mood disturbance, long-term corticosteroid therapy
- MeSH terms
- Arthritis, Rheumatoid, Mental Disorders, Dose-Response Relationship, Drug, Gastrointestinal Diseases, Glucocorticoids, Humans, Inflammation, Polymyalgia Rheumatica, Inflammatory Bowel Diseases
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