Reactions 1680, p8 - 2 Dec 2017 Glucocorticoid-related adverse events in ethnic Chinese patients In a cohort of ethnic Chinese patients, both the glucocorticoid dosage and intensity were associated with an increased risk of some adverse events, according to study results reported in the Journal of Rheumatology. The population-based study used data from Taiwan’s National Health Insurance Research Database (NHIRD). Patients newly diagnosed with systemic lupus erythematosus who received ≥1 prescription for systemic glucocorticoid treatment in 2001–2012 were identified. Every 90 days after the initial prescription, average prednisolone-equivalent doses and medication possession ratios (MPR) were calculated. The 11 288 patients were followed-up for a mean of 6.28 years. The most frequently identified adverse event was peptic ulcer (n=6251), followed by bacterial infection (n=5489), insomnia (n=4019), fungal infection (n=2568) and hypertension (n=2301). Events which occurred >1000 times included acne vulgaris, cataract, depression, dyslipidaemia, fracture, gout/hyperuricaemia, nausea/vomiting and osteoporosis. In multivariate generalized estimating equation models, some adverse events were associated with a joint effect of dose and intensity when compared to patients who did not receive glucocorticoids. There were higher risks in patients who received higher glucocorticoid doses (>10mg) and higher intensities (MPR ≥80%) compared with those who received lower glucocorticoid doses and lower intensities. This included osteonecrosis (adjusted odds ratios [OR] 2.87–9.09], osteoporosis (OR 1.71–3.67), bacterial infection (OR 2.12–3.89), Cushingoid syndrome (OR 6.51–62.03) and sleep disorder (OR 1.41–3.59). The authors note that these results suggest "that no consensus about a "safe" dose can be reached because even low-dose GC [glucocorticoids] may cause the loss of bone mineral density (BMD) and Cushingoid syndrome". For other adverse events, there was an increased risk in patients who received higher intensity therapy, even at a lower dose. This included acne vulgaris, cataract, hyperuricaemia peptic ulcer and viral hepatitis. For other events, there was an increased risk in patients who received higher doses. This included cardiovascular disease, fatty liver, fungal infection, glaucoma, myopathy, nausea/vomiting and tuberculosis. Chen H-L, et al. Cumulative Burden of Glucocorticoid-related Adverse Events in Patients with Systemic Lupus Erythematosus: Findings from a 12-year Longitudinal Study. The Journal of Rheumatology : 15 Nov 2017. Available from: URL: http://doi.org/10.3899/jrheum.160214 803285356 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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