title: Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug. A cross-sectional online survey of 820 patients.
abstract: Despite systemic glucocorticoids are widely used, risk factors for most of their adverse events and patients' beliefs about the drug are poorly known. An online survey was conducted between February and July 2013 through the website www.cortisone-info.fr . Demographic (e.g., age, gender) and therapeutic (e.g., type of prescribed glucocorticoid, duration of prescription) data were collected. Patients were further asked to answer questions about glucocorticoid-induced adverse events and their beliefs about efficacy and safety of the drug. Risk factors for adverse events and efficacy/safety beliefs were assessed using multivariate logistic regression models. Eight hundred twenty questionnaires were analyzed (women 74.3 %; median age 49 [34-62] years, median equivalent prednisone dosage 20 [10-48] mg/day). The most frequently reported adverse events were insomnia (n = 477, 58.2 %), mood disturbances (n = 411, 50.1 %), hyperphagia (n = 402, 49.0 %), and lipodystrophy (n = 387, 47.2 %). The risk of some adverse events (e.g., weight gain, easy bruising) increased with the duration of exposure while other adverse events (e.g., insomnia, mood disorders, epigastric pain) were present since the first days of exposure. The risk of hirsutism, altered wound healing, mood disturbances, weight gain, lipodystrophy, hyperphagia, and epigastric pain decreased with age. Cutaneous disorders, morphological changes, and epigastric pain were more frequently reported by women. Interestingly, patients prescribed prednisolone reported less adverse events than those prescribed prednisone. No adverse event, demographical or prescribing characteristics were associated with beliefs about efficacy while factors associated with safety concerns were age (OR: 1.2 [1.1-1.3] per 10-year increase), osteoporosis (OR: 3.3 [1.4-7.9]), easy bruising (OR: 1.6 [1.1-2.3]), insomnia (OR: 1.7 [1.2-2.4]), and weight gain (OR: 1.6 [1.1-2.2]). These results may help clinicians to adapt information speech, therapeutic education, and clinical and laboratory monitoring of patients prescribed glucocorticoid therapy.
authors.affiliation: Hôpital Saint Camille (Bry-sur-Marne, Val de Marne), Service de Médecine Interne, 2 rue des pères Camilliens, 94360, Bry-sur-Marne, France. clementmorin@live.fr.
authors.forename: Clément
authors.initials: C
authors.lastname: Morin
authors.affiliation: UPEC (Université Paris-Est Créteil Val de Marne), AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Fardet
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D001778:Blood Coagulation Disorders / Q000139:chemically induced*; D003430:Cross-Sectional Studies; D003875:Drug Eruptions / Q000209:etiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006628:Hirsutism / Q000139:chemically induced; D006801:Humans; D006963:Hyperphagia / Q000139:chemically induced*; D008060:Lipodystrophy / Q000139:chemically induced*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000139:chemically induced*; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000139:chemically induced*; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced*; D011795:Surveys and Questionnaires; D013997:Time Factors; D015430:Weight Gain
chemical_list: D005938:Glucocorticoids
keywords: Adverse events; Glucocorticoids; Online survey