Oral corticosteroid burst increases risk of adverse events in children: JAMA
Taiwan: Oral corticosteroid burst treatment in children with respiratory and allergic conditions increases the risk of sepsis, pneumonia, and GI bleeding by 1.4- to 2.2-fold, finds a recent study in JAMA Pediatrics. These adverse events occur within the first month after initiation of corticosteroid therapy and are attenuated during the subsequent 31 to 90 days.
Oral corticosteroids are used for the treatment of several inflammatory diseases including inflammatory bowel disease, rheumatoid arthritis, and asthma, as recommended by international guidelines. The long-term use of oral corticosteroids is known to be associated with subsequent adverse events, including Cushingoid features, gastrointestinal (GI) bleeding, infections, glaucoma, hyperglycemia, cardiovascular diseases, and osteoporosis.
According to the authors, not much is known about the potential harms of corticosteroid bursts, defined as courses of oral corticosteroids for 14 or fewer days, particularly in children. To determine the same, Tsung-Chieh, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues aimed to quantify the associations of corticosteroid bursts with severe adverse events, including gastrointestinal (GI) bleeding, sepsis, pneumonia, and glaucoma, in children.
For this purpose, the researchers used data derived from the National Health Insurance Research Database in Taiwan from January 1, 2013, to December 31, 2017, on children younger than 18 years of age and used a self-controlled case series design.
Incidence rates were calculated of 4 severe adverse events (GI bleeding, sepsis, pneumonia, and glaucoma) in children who did or did not receive corticosteroid bursts.
Among 4 542 623 children, 23% (mean age, 9.7 years) were prescribed a single corticosteroid burst. The most common indications were acute respiratory tract infections and allergic diseases.
Key findings of the study include:
- The incidence rate differences per 1000 person-years between children administered a single corticosteroid burst and those not prescribed corticosteroids were 0.60 for GI bleeding, 0.03 for sepsis, 9.35 for pneumonia, and 0.01 for glaucoma.
- The IRRs within 5 to 30 days after initiating corticosteroid bursts were 1.41 for GI bleeding, 2.02 for sepsis, 2.19 for pneumonia, and 0.98 for glaucoma; the IRRs within the subsequent 31 to 90 days were 1.10 for GI bleeding, 1.08 for sepsis, 1.09 for pneumonia, and 0.95 for glaucoma.
"Clinicians should be aware of these rare but potentially serious adverse events associated with use of corticosteroid bursts for children, particularly during the first month after corticosteroid initiation," wrote the authors. "These findings provide real-world evidence for clinicians and guideline developers to implement strategies with optimal benefit to risk ratios for preventing avoidable harms from the use of corticosteroid bursts for children."
The study titled, "Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children," is published in the journal JAMA Pediatrics.