Adverse events related to low dose corticosteroids in autoimmune hepatitis.
Adolescent
Adrenal Cortex Hormones
/ administration & dosage
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Drug-Related Side Effects and Adverse Reactions
/ epidemiology
Female
Fractures, Bone
/ chemically induced
Glucocorticoids
/ administration & dosage
Hepatitis, Autoimmune
/ drug therapy
Humans
Male
Middle Aged
Retrospective Studies
Young Adult
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
26
06
2019
revised:
20
07
2019
accepted:
16
09
2019
pubmed:
17
10
2019
medline:
26
5
2020
entrez:
17
10
2019
Statut:
ppublish
Résumé
Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases. To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis. We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25%) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.
Sections du résumé
BACKGROUND
Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases.
AIM
To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis.
METHODS
We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects.
RESULTS
A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25%) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years.
CONCLUSIONS
Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.
Identifiants
pubmed: 31617229
doi: 10.1111/apt.15528
pmc: PMC6899908
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Glucocorticoids
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1120-1126Investigateurs
N M van Gerven
(NM)
J Ph Kuijvenhoven
(JP)
T C M A Schreuder
(TCMA)
E J van der Wouden
(EJ)
J J M van Meyel
(JJM)
L C Baak
(LC)
P H G M Stadhouders
(PHGM)
M Klemt-Kropp
(M)
M A M T Verhagen
(MAMT)
A Bhalla
(A)
J W den Ouden
(JW)
U Beuers
(U)
K J van Erpecum
(KJ)
H R van Buuren
(HR)
J T Brouwer
(JT)
Informations de copyright
© 2019 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.
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