What are the negative effects of corticosteroids (cortico-steroids)?

From the Guidelines

Prolonged use of corticosteroids is associated with numerous severe side effects, including increased infection risk, osteoporosis, suppression of the hypothalamic-pituitary-adrenal axis, diabetes, weight gain, and cardiovascular disease, which can significantly impact morbidity, mortality, and quality of life. The negative effects of corticosteroids are a significant concern, particularly with long-term use, as defined by continuous therapy for more than 3 months 1. Some of the common side effects include:

• Increased infection risk
• Osteoporosis
• Suppression of the hypothalamic-pituitary-adrenal axis
• Diabetes
• Weight gain
• Cardiovascular disease These side effects can lead to serious complications, such as adrenal suppression, where the body's natural production of cortisol decreases, potentially leading to adrenal crisis if the medication is stopped abruptly 1. Furthermore, there is evidence of increased mortality in IBD patients on long-term steroids, with a study showing that prolonged steroid use carries greater mortality compared with patients starting anti-TNF therapy 1.

The risks associated with corticosteroid use are dose- and duration-dependent, which is why healthcare providers typically prescribe the lowest effective dose for the shortest time possible 1. It is essential to monitor patients on long-term corticosteroid therapy for potential side effects and to consider alternative treatments to minimize these negative effects. The British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults recommend careful use of corticosteroids to avoid steroid dependency and excess, which can have severe consequences for patients 1.

In clinical practice, it is crucial to weigh the benefits of corticosteroid use against the potential risks and to consider the individual patient's needs and medical history when making treatment decisions. By doing so, healthcare providers can minimize the negative effects of corticosteroids and optimize patient outcomes. The evidence suggests that prolonged steroid use should be avoided, and alternative treatments should be considered to reduce the risk of severe side effects and improve patient quality of life 1.

From the FDA Drug Label

Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. Musculoskeletal Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation (i.e., decreasing absorption and increasing excretion) and inhibition of osteoblast function. Psychiatric derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Ophthalmic Intraocular pressure may become elevated in some individuals Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision As prolonged use may cause adrenal insufficiency and make patients dependent on corticosteroids, Vaccines Patients on corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Pregnancy Teratogenic Effects Pregnancy Category C Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose Nursing Mothers Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects Pediatric Use The adverse effects of corticosteroids in pediatric patients are similar to those in adults

The negatives of corticosteroids include:

• Musculoskeletal effects: decreased bone formation, increased bone resorption, and inhibition of osteoblast function, which may lead to osteoporosis and inhibition of bone growth in pediatric patients.
• Psychiatric effects: derangements ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations.
• Ophthalmic effects: elevated intraocular pressure.
• Adrenal insufficiency: prolonged use may cause dependence on corticosteroids.
• Vaccine interactions: diminished response to toxoids and live or inactivated vaccines.
• Teratogenic effects: corticosteroids have been shown to be teratogenic in many species.
• Effects on nursing mothers: systemically administered corticosteroids appear in human milk and could suppress growth or interfere with endogenous corticosteroid production.
• Pediatric effects: similar to those in adults, including decreased growth velocity 2, 2.

From the Research

Negatives of Corticosteroids

• Adrenal insufficiency: Chronic corticosteroid use can lead to adrenal insufficiency, a condition where the adrenal glands do not produce enough hormones 3, 4.
• Systemic side effects: Corticosteroids can cause numerous systemic side effects, including increases in blood glucose levels, reduction in immune function, and increased risk of infections 5, 6.
• Toxicity to articular cartilage: Corticosteroids can cause toxic damage to articular cartilage, leading to joint pain and osteoarthritis 5.
• Bone fracture: Long-term corticosteroid exposure is associated with an increased risk of bone fracture, with a prevalence of 21-30% 6.
• Gastrointestinal bleeding: Corticosteroids can increase the risk of gastrointestinal bleeding, particularly in the in-patient setting 7.
• Psychiatric syndromes: Corticosteroids can cause psychiatric syndromes, including anxiety, depression, and psychosis 7.
• Ophthalmic complications: Corticosteroids can cause ophthalmic complications, including cataracts and glaucoma 6, 7.
• Tuberculosis reactivation: Corticosteroids can reactivate tuberculosis, particularly in patients with a history of tuberculosis 7.
• Bacterial sepsis: Corticosteroids can increase the risk of bacterial sepsis, particularly in patients with compromised immune systems 7.
• Economic impact: Long-term corticosteroid use can have a significant economic impact, with increased healthcare resource utilization and costs 6.