Leeds, UK—Even small doses of oral steroids used to treat patients with certain inflammatory diseases can significantly increase the risk of infection, a new study cautions.

The research, published in CMAJ (Canadian Medical Association Journal) focused on patients with polymyalgia rheumatica and/or giant-cell arteritis in England. University of Leeds–led researchers focused on nearly 40,000 adults, mean age 73 years, with those diseases to gauge the effect of steroid treatment on infection risk.

The study reported higher absolute risks of infection when patients were taking oral steroids than when they were not taking them. The research looked at the use of prednisolone, prednisone, and hydrocortisone.

Of the 39, 938 patients being treated in 389 family practices between 1998 and 2017, 22,234 (55.7%) had at least one infection over a median follow-up period of 4.8 years, with 5,937 (26.7%) requiring hospital admission and 1,616 (7.3%) dying within 7 days of diagnosis. The most common types of infections were lower respiratory tract ailments, conjunctivitis, and herpes zoster, the study notes.

Researchers calculate cumulative risks of all-cause infection at 18.3% (95% CI, 17.9%-18.7%) at 1 year, 54.7% (95% CI, 54.1%-55.2%) at 5 years; and 76.9% (95% CI, 76.2%-77.5%) at 10 years. The study adds that the increases in adjusted hazard ratios for all-cause infection per 5-mg prednisolone-equivalent daily dose increase and per 1,000 mg-cumulative dose increase in the last year from the patient’s end date of follow-up were 1.13 (95% CI, 1.12-1.14) and 1.50 (95% CI, 1.49-1.52), respectively.

At the same time, adjusted HRs associated with periods of current glucocorticoid versus no glucocorticoid use ranged from 1.48 (95% CI, 1.39-1.57) for fungal to 1.70 (95% CI, 1.60-1.80) for bacterial infection. Dose-related associations were determined for bacterial, viral, parasitic, and fungal infections, which appear to be little affected by patient age, duration of underlying chronic disease, and baseline vaccination status, according to the study team.

“We quantified the excess risk of all-cause, bacterial, viral, parasitic and fungal infection conferred by oral glucocorticoids in people with polymyalgia rheumatica or giant cell arteritis and found strong dose responses for all types, even at daily doses of less than 5 mg prednisolone,” study authors conclude.

“In periods with prescribed medication, patients’ risk was 50% higher than when it was not prescribed,” the authors add. “Increases in risk ranged from 48% for fungal to 70% for bacterial infections.”

Researchers urge more education about the risk of infection, need for symptom identification, prompt treatment, timely vaccination, and documentation of history of chronic infection.

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