Taoyuan, Taiwan—While the adverse effects of long-term use of oral corticosteroids are well documented, a new study raises concerns about short-term-use prescriptions, 14 or fewer days, in children.

Chang Gung Memorial Hospital–led researchers sought to quantify the associations of so-called corticosteroid bursts with severe adverse events, including gastrointestinal (GI) bleeding, sepsis, pneumonia, and glaucoma, in children.

The authors point out, “It has been well recognized for more than a half century that long-term use of oral corticosteroids is associated with subsequent adverse events, including Cushingoid features, GI bleeding, infections, glaucoma, hyperglycemia, cardiovascular diseases, and osteoporosis. Clinicians, therefore, caution against long-term use of oral corticosteroids unless the potential benefits outweigh the potential risks.”

On the other hand, they suggest that little data has been available about the potential harms of corticosteroid bursts, which are defined as courses of oral corticosteroids for 14 or fewer days. “Nowadays, use of corticosteroid bursts are considered harmless, an assumption supported by years of clinical data linking exposure duration with toxic effects,” they add, noting that clinicians currently prescribe short courses of oral corticosteroids to 21% of the general adult population in the U.S.

Their cohort study, with results published in JAMA Pediatrics, used data from the National Health Insurance Research Database in Taiwan from January 1, 2013, to December 31, 2017, with analysis in early 2020. The focus was on the 23% of those younger than age18 years—about 1.1 million, with 51.1% boys and a mean [SD] age of 9.7 [5.8] years)— who were prescribed a minimum of a single corticosteroid burst. The most common indications for corticosteroid prescriptions were acute respiratory tract infections and allergic diseases.

Results indicate that the incidence-rate differences per 1,000 person-years between children administered a single corticosteroid burst and those not prescribed corticosteroids were:
• 0.60 (95% CI, 0.55-0.64) for GI bleeding
• 0.03 (95% CI, 0.02-0.05) for sepsis
• 9.35 (95% CI, 9.19-9.51) for pneumonia
• 0.01 (95% CI, 0.01-0.03) for glaucoma.

The authors calculate incidence rate ratio (IRRs) within 5 to 30 days after initiating corticosteroid bursts as 1.41 (95% CI, 1.27-1.57) for GI bleeding; 2.02 (95% CI, 1.55-2.64) for sepsis; 2.19 (95% CI, 2.13-2.25) for pneumonia; and 0.98 (95% CI, 0.85-1.13) for glaucoma. In addition, the IRRs within the subsequent 31 to 90 days were 1.10 (95% CI, 1.02-1.19) for GI bleeding; 1.08 (95% CI, 0.88-1.32) for sepsis; 1.09 (95% CI, 1.07-1.11) for pneumonia; and 0.95 (95% CI, 0.85-1.06) for glaucoma, according to the study.

“This study suggests that corticosteroid bursts, which are commonly prescribed for children with respiratory and allergic conditions, are associated with a 1.4- to 2.2-fold increased risk of GI bleeding, sepsis, and pneumonia within the first month after initiation of corticosteroid therapy that is attenuated during the subsequent 31 to 90 days,” the researchers conclude.

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