Association of oral corticosteroid bursts with severe adverse events in children

1. Among a large cohort of children in Taiwan, oral corticosteroids prescribed for <14 days were associated with an increased risk of gastrointestinal (GI) bleeds, sepsis, and pneumonia during the first month of therapy initiation.

Evidence level rating: 2 (Good)

Oral corticosteroids are commonly prescribed to children for various inflammatory conditions, including asthma, inflammatory bowel disease, and bronchitis. Though the adverse effects of long-term corticosteroid use have been thoroughly explored in scientific literature, the short-term risks of therapies are not as well characterized. In this population-based cohort study, data from medical claims records and prescription data from the National Health Insurance Research Database from January, 2013 to December, 2017 was used to further explore the adverse events and potential risks of corticosteroid bursts, defined as treatment courses of 14 or fewer days. 1,064,587 participants younger than 18 years who received one burst of corticosteroid therapy were included in this self-controlled case series. Each participant’s risk of severe adverse events within the pre-treatment period (5-90 days prior to initiation of therapy) was compared to the risk within each of the two post-treatment periods (5-30 days and 31-90 days after initiation of therapy). The adverse events examined were GI bleeds, sepsis, pneumonia, and glaucoma. The study calculated incident rate ratios (IRR) by comparing the incident rates of severe events within each post-treatment period to the incident rates of severe events in the reference period (pre-treatment). During the first post-treatment period (5-30 days after therapy), the IRR was 1.41 (95% CI, 1.27-1.57) for GI bleeds, 2.02 (95% CI, 1.55-2.64) for sepsis, 2.19 (95% CI, 2.13-2.25) for pneumonia, and 0.98 (95% CI, 0.85-1.13) for glaucoma. During the second post-treatment period (31-90 days after therapy), the IRR was 1.10 (95% CI, 1.02-1.19) for GI bleeds, 1.08 (95% CI, 0.88-1.32) for sepsis, 1.09 (95% CI, 1.07-1.11) for pneumonia, and 0.95 (95% CI, 0.85-1.06) for glaucoma. Overall, the study demonstrates that corticosteroid bursts prescribed to children are associated with a 1.4 to 2.2-fold increased risk of GI bleeds, sepsis, and pneumonia, and provides data to further inform shared decisioned making between practitioners and patients.

Click to read the study in JAMA Pediatrics

Image: PD

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