From the Guidelines
Long-term use of prednisone is not directly associated with pancreatic insufficiency, according to the most recent evidence. The side effects of prolonged prednisone use are well-documented and include cosmetic, systemic, and quality of life issues, as outlined in the 2020 practice guidance and guidelines from the American Association for the Study of Liver Diseases 1. These side effects include facial rounding, hirsutism, alopecia, weight gain, glucose intolerance, hypertension, and osteoporosis, among others. However, pancreatic insufficiency is not listed as a potential side effect of prednisone use.
Potential Confounding Factors
It's essential to note that while prednisone does not directly cause pancreatic insufficiency, it can exacerbate existing conditions, such as diabetes, which may lead to symptoms that could be mistaken for pancreatic issues. The guidelines recommend actively tapering prednisone to the lowest steroid dose needed for remission and attempting withdrawal after remission, as well as monitoring for potential side effects, including eye examinations, lifestyle interventions for metabolic syndrome, and bone density monitoring 1.
Diagnosis and Treatment of Pancreatic Insufficiency
If pancreatic insufficiency is suspected, it is crucial to evaluate the patient for common causes, such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or previous pancreatic surgery. Treatment for pancreatic insufficiency typically involves pancreatic enzyme replacement therapy (PERT) to aid digestion. The provided evidence does not support a direct link between long-term prednisone use and pancreatic insufficiency, and therefore, patients experiencing digestive symptoms while on prednisone should be evaluated for other potential causes.
Key Takeaways
- Long-term prednisone use is not directly associated with pancreatic insufficiency.
- Prednisone can exacerbate existing conditions, such as diabetes.
- Patients experiencing digestive symptoms while on prednisone should be evaluated for other potential causes.
- Treatment for pancreatic insufficiency typically involves pancreatic enzyme replacement therapy (PERT).
From the Research
Long-term Use of Prednisone and Pancreatic Insufficiency
- There is no direct evidence in the provided studies that long-term use of prednisone (corticosteroid) causes pancreatic insufficiency 2, 3, 4, 5, 6.
- A study on autoimmune pancreatitis after oral prednisolone therapy found no deterioration of pancreatic exocrine function in any of the patients 2.
- Other studies focused on pancreatic exocrine insufficiency (PEI) and its treatment with pancreatic enzyme replacement therapy (PERT), but did not investigate the effect of prednisone on pancreatic function 3, 4, 6.
- A study on corticosteroid-induced clinical adverse events found that lipodystrophy, neuropsychiatric disorders, and skin disorders were common adverse events of long-term prednisone therapy, but did not mention pancreatic insufficiency 5.