Impact of corticosteroid-related symptoms in patients with immune thrombocytopenic purpura: results of a survey of 985 patients.
BACKGROUND
Corticosteroid (CS) therapy is effective in many patients with immune thrombocytopenic purpura (ITP), although it is associated with adverse effects.


OBJECTIVE
This study was conducted to describe the CS-related symptom experience of adult patients with ITP and to compare the symptom experience of current users of CS, previous users of CS, and those who have never used CS.


METHODS
In 2006, adult members of the Platelet Disorder Support Association (PDSA) who were listed in the organization's database, resided in the United States, and had a diagnosis of ITP were invited to participate in a Web-based survey. Symptom experience was assessed using 33 CS-related symptoms derived from a scale developed for use in patients undergoing organ transplantation. Symptom experience over the past 4 weeks was measured in terms of the occurrence of symptoms (rated on a 5-point scale from 1 [never occurring] to 5 [always occurring]) and the distress associated with those symptoms (rated on a 5-point Likert scale from 0 [not at all distressing] to 4 [extremely distressing]). Respondents were categorized according to 4 patterns of CS use: current users, nonusers, previous users who stopped CS use <6 months earlier, and previous users who stopped CS use >or=6 months earlier.


RESULTS
The survey was completed by 985 patients with ITP (8.2% of the PDSA membership). The median age of the sample was 47 years, and the ratio of women to men was 3:1. One hundred sixteen patients (11.8%) were current CS users, 171 (17.4%) were nonusers, 99 (10.1%) had stopped CS use <6 months earlier, and 599 (60.8%) had stopped CS use >or=6 months earlier. In all 4 groups, back pain, fatigue, sleep difficulties, muscle weakness, and difficulty seeing well were reported to be the most frequently occurring and most distressing symptoms. Current CS users and those who stopped CS treatment <6 months earlier also reported bruises to be among their most frequent and distressing symptoms. Twenty-five of the 33 symptoms occurred more frequently in current CS users than in nonusers, and 30 symptoms occurred more frequently in current users than in previous users who had stopped CS use >or=6 months earlier. Symptom occurrence was significantly greater for current users compared with those who stopped CS use <6 months earlier for puffy face (q = 0.003), excessive appetite (q = 0.002), changed facial features (q = 0.033), and buffalo hump (q = 0.048). Patients who had stopped CS use <6 months earlier reported 20 of the 33 symptoms significantly more often than those who had stopped CS use >or=6 months earlier (q < 0.05). The only symptoms reported significantly more often in patients who had stopped CS use >or=6 months earlier compared with nonusers were buffalo hump and bruises (q < 0.05). The distress associated with bruises was significantly higher in current users compared with nonusers and compared with previous users who had stopped CS use >or=6 months earlier (both, q = 0.047). Current users also reported significantly greater distress than nonusers for puffy face and excessive appetite (both, q = 0.047). Changed facial features was significantly more distressing in current users compared with those who had stopped CS use >or=6 months earlier (q = 0.047).


CONCLUSIONS
Different symptom profiles emerged based on the pattern of CS use. Patients who were currently using CS or who had stopped CS treatment <6 months earlier reported more symptoms than did patients who had never received CS or who had stopped CS treatment =6 months earlier.
Berti
Dana
D
Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
Moons
Philip
P
Dobbels
Fabienne
F
Deuson
Robert
R
Janssens
Ann
A
De Geest
Sabina
S
D000328:Adult; D003625:Data Collection; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000139:chemically induced; D013997:Time Factors
D005938:Glucocorticoids