Population-based assessment of adverse events associated with long-term glucocorticoid use.
OBJECTIVE
The frequency of many adverse events (AEs) associated with low-dose glucocorticoid use is unclear. We sought to determine the prevalence of glucocorticoid-associated AEs in a large US managed care population.


METHODS
Using linked administrative and pharmacy claims, adults receiving >or=60 days of glucocorticoids were identified. These individuals were surveyed about glucocorticoid use and symptoms of 8 AEs commonly attributed to glucocorticoid use.


RESULTS
Of the 6,517 eligible glucocorticoid users identified, 2,446 (38%) returned the mailed survey. Respondents were 29% men with a mean +/- SD age of 53 +/- 14 years; 79% were white and 13% were African American. Respondents had a mean +/- SD of 7 +/- 3 comorbid conditions and were prescribed a mean +/- SD prednisone-equivalent dosage of 16 +/- 14 mg/day. More than 90% of individuals reported at least 1 AE associated with glucocorticoid use; 55% reported that at least 1 AE was very bothersome. Weight gain was the most common self-reported AE (70% of the individuals), cataracts (15%) and fractures (12%) were among the most serious. After multivariable adjustment, all AEs demonstrated a strong dose-dependent association with cumulative glucocorticoid use. Among users of low-dose therapy (<or=7.5 mg of prednisone per day), increasing duration of use was significantly associated with acne, skin bruising, weight gain, and cataracts.


CONCLUSIONS
The prevalence of 8 commonly attributed self-reported glucocorticoid-associated AEs was significantly associated with cumulative and average glucocorticoid dose in a dose-dependent fashion. Physicians should be vigilant for glucocorticoid-related AEs and should counsel patients about possible risks, even among low-dose long-term users.
Curtis
Jeffrey R
JR
University of Alabama at Birmingham, 35294, USA.
Westfall
Andrew O
AO
Allison
Jeroan
J
Bijlsma
Johannes W
JW
Freeman
Allison
A
George
Varghese
V
Kovac
Stacey H
SH
Spettell
Claire M
CM
Saag
Kenneth G
KG
D000284:Administration, Oral; D002386:Cataract / Q000139:chemically induced / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000453:epidemiology*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D005938:Glucocorticoids