Population-based assessment of adverse events associated with long-term glucocorticoid use

被引:405
作者
Curtis, Jeffrey R.
Westfall, Andrew O.
Allison, Jeroan
Bijlsma, Johannes W.
Freeman, Allison
George, Varghese
Kovac, Stacey H.
Spettell, Claire M.
Saag, Kenneth G.
机构
[1] Univ Alabama, Div Clin Immunol & Rheumatol, Birmingham, AL 35294 USA
[2] Univ Med Ctr, Utrecht, Netherlands
[3] Aetna Inc, Aetna Integrated Informat, Blue Bell, PA USA
[4] Durham VA Med Ctr, Durham, NC USA
[5] Duke Univ, Durham, NC USA
来源
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH | 2006年 / 55卷 / 03期
关键词
glucocorticoids; adverse events; cataracts; fractures;
D O I
10.1002/art.21984
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 >= 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 (<= 7.5 mg of prednisone per day), increasing duration of use was significantly associated with acne, skin bruising, weight gain, and cataracts. Conclusion. 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.
引用
收藏
页码:420 / 426
页数:7
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