Millions of times a year, Americans receive prescriptions for a week’s worth of steroid pills, hoping to ease a backache or quell a nagging cough or allergy symptoms. But a new study suggests that they and their doctors might want to pay more attention to the potential adverse effects of these medications, according to a study from the University of Michigan.
Patients receiving short-term corticosteroid treatment were more likely to break a bone, have a potentially dangerous blood clot, or develop life-threatening sepsis after their treatment compared with similar adults who didn’t use steroids.
The findings were published in the British Medical Journal.
“Although physicians focus on the long-term consequences of steroids, they don’t tend to think about potential risks from short-term use,” said lead author Akbar Waljee, MD, MSc. “We see a clear signal of higher rates of these three serious events within 30 days of filling a prescription. We need to understand that steroids do have a real risk and that we may use them more than we really need to. This is so important because of how often these drugs are used.”
Using anonymous insurance claims data, the researchers found that half of the patients with prescriptions for oral steroids had obtained them for six diagnoses related to back pain, allergies, or respiratory-tract infections, including bronchitis.
Nearly half received a six-day prepackaged methylprednisolone “dosepak,” which tapered the dose of steroids from the highest to the lowest. Waljee noted that when oral steroids are sold as individual pills, they can cost less than $1 for a seven-day course, but the prepackaged form can cost several times that. He also observed that the prepackaged form starts with a relatively high dose that may not always be necessary.
In the new study, users of short-term steroids were more likely to be under 65 years of age, white, and female, and to have multiple health conditions. More than half lived in the southern U.S. The researchers excluded anyone who used steroids during the year preceding the study; anyone who took inhaled or injected steroids during the study years; anyone who took oral steroids for more than 30 days; and subjects who had cancer or had received transplants.
Waljee and his colleagues found higher rates of sepsis, venous thromboembolism (VTE), and fractures among short-term steroid users using several statistical approaches.
First, they compared short-term steroid users with non-steroid users, looking for broken bones, VTE, or sepsis within five to 90 days after either the clinic visit closest to when the steroid prescription was filled, or a routine clinic visit for non-steroid users. This calculation provided the absolute risk.
The investigators found that 0.05% of those receiving steroids were admitted to a hospital with a primary diagnosis of sepsis compared with 0.02% of non-steroid users. For VTE, the corresponding rates were 0.14% and 0.09%, respectively, and for fracture, they were 0.51% and 0.39%.
This analysis, however, was unable to account for all of the individual differences between steroid users and non-users. For that comparison, the investigators looked at the rates of the three complications among short-term steroid users before and after they received steroids. Sepsis rates were five times higher during the 30 days after a steroid prescription; VTE rates were more than three times as high; and fracture rates were nearly twice as high as those among patients that did not receive steroids.
Finally, the researchers compared the steroid users with a sample of non-steroid users who had the same respiratory conditions. The differences in rates among all three health problems were still higher, as expressed by the incidence rate ratio. Steroid users had more than five times the rate of sepsis; nearly three times the rate of VTE; and two times the rate of fracture.
Waljee noted that the broad effect of corticosteroids on the three key complications may have had its roots in how these drugs work: they reduce inflammation by mimicking hormones produced by the body, which can also induce changes that put patients at additional risk of serious events.
Based on the study results, Waljee advises prescribers to use the smallest amount of corticosteroids possible based on the condition being treated. “If there are alternatives to steroids, we should use those when possible,” he said. “Steroids may work faster, but they aren’t as risk-free as you might think.”