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

From the Guidelines

Corticosteroids should be used with caution due to their significant negative effects, particularly with long-term use, which can lead to increased infection risk, osteoporosis, suppression of the hypothalamic-pituitary-adrenal axis, diabetes, weight gain, and cardiovascular disease, as well as increased mortality in patients with inflammatory bowel disease (IBD) 1. The use of corticosteroids is associated with numerous side effects, including:

• Increased infection risk
• Osteoporosis
• Suppression of the hypothalamic-pituitary-adrenal axis
• Diabetes
• Weight gain
• Cardiovascular disease These side effects are particularly concerning with prolonged use, often defined as continuous therapy for more than 3 months 1. Additionally, there is evidence of increased mortality in IBD patients on long-term steroids, with a significant increase in mortality for Crohn’s disease patients taking more than 3000 mg prednisolone equivalent in 1 year 1. It is essential to carefully monitor patients on corticosteroids and use the lowest effective dose for the shortest duration possible to minimize these risks. Preventive measures, such as calcium and vitamin D supplementation for bone health, should also be considered to mitigate the negative effects of corticosteroids. Overall, the potential benefits of corticosteroids must be carefully weighed against their significant risks, particularly in patients with IBD, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

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 If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored. Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision Following prolonged therapy, withdrawal of corticosteroids may result in symptoms of the corticosteroid withdrawal syndrome including, myalgia, arthralgia, and malaise. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. The linear growth of pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives.

The negatives of corticosteroids include:

• Musculoskeletal effects: decreased bone formation, increased bone resorption, and inhibition of osteoblast function, which may lead to osteoporosis and growth inhibition in pediatric patients.
• Psychiatric effects: derangements ranging from euphoria to frank psychotic manifestations.
• Ophthalmic effects: elevated intraocular pressure.
• Withdrawal syndrome: symptoms including myalgia, arthralgia, and malaise after prolonged therapy.
• Growth effects: decreased growth velocity in pediatric patients.
• Adrenal insufficiency: patients may become dependent on corticosteroids and experience adrenal insufficiency if therapy is discontinued abruptly.
• Increased risk of infection: patients on corticosteroid therapy may exhibit a diminished response to vaccines and may be at increased risk of infection.
• Other effects: fluid retention, hypertension, diabetes mellitus, peptic ulcers, cataracts, and thromboembolism 2, 2, 2.

From the Research

Negatives of Corticosteroids

• Corticosteroids are known to be associated with certain toxicities, including bone fracture, infection, and gastrointestinal bleeding, with long-term use increasing the risk of these adverse events 3.
• Secondary adrenal insufficiency (AI) can occur as a result of exogenous corticosteroid therapy, which can be life-threatening in the event of an adrenal crisis 4.
• Commonly-cited adverse events associated with long-term corticosteroid exposure include:
  • Hypertension (prevalence >30%)
  • Bone fracture (21%-30%)
  • Cataract (1%-3%)
  • Nausea, vomiting, and other gastrointestinal conditions (1%-5%)
  • Metabolic issues (e.g., weight gain, hyperglycemia, and type 2 diabetes) 3
• The risk of adrenal insufficiency after discontinuation of glucocorticoid occurs frequently, and there is no administration form, dosing, treatment duration, or underlying disease for which adrenal insufficiency can be excluded with certainty 5.
• Corticosteroids have been associated with severe complications, including avascular necrosis, gastrointestinal bleeding, myocardial infarction, heart failure, cerebrovascular events, diabetes mellitus, psychiatric syndromes, ophthalmic complications, tuberculosis reactivation, and bacterial sepsis 6.
• Increased daily and cumulative doses of corticosteroids are associated with increased excess risk of complications, with cumulative doses greater than 430 mg prednisone equivalent increasing the excess risk of avascular necrosis 6.
• Long-term corticosteroid use can expose the body to side effects and can cause long-term health concerns, making it important to be aware of the risks of long-term corticosteroid use 7.