From the Guidelines
Corticosteroids have significant negative effects with long-term use, including increased infection risk, osteoporosis, suppression of the hypothalamic-pituitary-adrenal axis, diabetes, weight gain, and cardiovascular disease, which can lead to increased mortality in patients with inflammatory bowel disease (IBD) 1. The use of corticosteroids is effective in inducing clinical remission in IBD patients, but they do not have a role in preventing relapse and can lead to steroid dependency or excess, which is defined as an inability to wean below 10 mg of prednisolone or 3 mg of budesonide within 3 months of starting, or disease flare within 3 months of stopping steroids 1. Some of the key negative effects of corticosteroids include:
- Increased infection risk
- Osteoporosis
- Suppression of the hypothalamic-pituitary-adrenal axis
- Diabetes
- Weight gain
- Cardiovascular disease Prolonged steroid use, often defined as continuous therapy for more than 3 months, is associated with these numerous side effects, and 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. Healthcare providers should aim to use the lowest effective dose for the shortest time possible to minimize the risk of adverse effects, and consider alternative treatments to reduce the reliance on corticosteroids and prevent long-term complications 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 is a common negative effect of long-term corticosteroid use, as seen in a case study where a 71-year-old woman was diagnosed with secondary adrenal insufficiency after chronic corticosteroid treatment 3.
- The risk of adrenal insufficiency varies by route of administration, disease, treatment dose, and duration, with higher doses and longer use giving the highest risk 4.
- Long-term corticosteroid exposure is associated with various adverse events, including:
- Corticosteroids are also associated with complications such as:
- The economic impact of corticosteroid use is significant, with per-annum incremental costs relative to nonusers ranging from $5700 in low-dose users to $29,000 in high-dose users 5.
- The optimal strategy to ensure early identification and treatment of adrenal insufficiency and safe corticosteroid withdrawal in routine clinical practice remains to be defined 7.