Burst Case Scenario: Why Shorter May Not Be Any Better When It Comes to Corticosteroids

Editorials1 September 2020Burst Case Scenario: Why Shorter May Not Be Any Better When It Comes to CorticosteroidsBeth I. Wallace, MD, MSc and Akbar K. Waljee, MDBeth I. Wallace, MD, MScCenter for Clinical Management Research at VA Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at Michigan Medicine, Ann Arbor, Michigan (B.I.W., A.K.W.)Search for more papers by this author and Akbar K. Waljee, MDCenter for Clinical Management Research at VA Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at Michigan Medicine, Ann Arbor, Michigan (B.I.W., A.K.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4234 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Seventy years ago, Phillip Hench and colleagues (1) described striking clinical improvement in 21 patients with rheumatoid arthritis who were given cortisone. The same article described in detail “certain side effects” that affected most patients, including fluid retention, hypertension, psychiatric disturbances, cushingoid habitus, and hyperglycemia. Hench's discovery was touted as a “miracle cure” for devastating chronic inflammatory conditions, and it led first to prevalent use of long-term, high-dose corticosteroids, then to increasing recognition of their severe adverse effects. Soon, many wondered if such “treatment with cortisone [was] worth while” (2), given its unfavorable toxicity profile.This year, clinicians will prescribe ...References1. Hench PS, Kendall EC, Slocumb CH, et al. Effects of cortisone acetate and pituitary ACTH on rheumatoid arthritis, rheumatic fever and certain other conditions. Arch Intern Med (Chic). 1950;85:545-666. [PMID: 15411248] CrossrefMedlineGoogle Scholar2. Freyberg RH, Traeger CH, Patterson M, et al. Problems of prolonged cortisone treatment for rheumatoid arthritis; further investigations. J Am Med Assoc. 1951;147:1538-43. [PMID: 14873721] CrossrefMedlineGoogle Scholar3. Wallace BI, Lin P, Kamdar N, et al. Patterns of glucocorticoid prescribing and provider-level variation in a commercially insured incident rheumatoid arthritis population: a retrospective cohort study. Semin Arthritis Rheum. 2020;50:228-236. [PMID: 31522762] doi:10.1016/j.semarthrit.2019.09.002 CrossrefMedlineGoogle Scholar4. Bénard-Laribière A, Pariente A, Pambrun E, et al. Prevalence and prescription patterns of oral glucocorticoids in adults: a retrospective cross-sectional and cohort analysis in France. BMJ Open. 2017;7:e015905. [PMID: 28760791] doi:10.1136/bmjopen-2017-015905 CrossrefMedlineGoogle Scholar5. Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. [PMID: 28404617] doi:10.1136/bmj.j1415 CrossrefMedlineGoogle Scholar6. Dvorin EL, Lamb MC, Monlezun DJ, et al. High frequency of systemic corticosteroid use for acute respiratory tract illnesses in ambulatory settings. JAMA Intern Med. 2018;178:852-854. [PMID: 29482204] doi:10.1001/jamainternmed.2018.0103 CrossrefMedlineGoogle Scholar7. Bloechliger M, Reinau D, Spoendlin J, et al. Adverse events profile of oral corticosteroids among asthma patients in the UK: cohort study with a nested case-control analysis. Respir Res. 2018;19:75. [PMID: 29699563] doi:10.1186/s12931-018-0742-y CrossrefMedlineGoogle Scholar8. Yao T, Huang Y, Chang S, et al. Association between oral corticosteroid bursts and severe adverse events. A nationwide population-based cohort study. Ann Intern Med. 2020;173:325-30. [PMID: 32628532]. doi:10.7326/M20-0432 LinkGoogle Scholar9. Hay AD, Little P, Harnden A, et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. JAMA. 2017;318:721-730. [PMID: 28829884] doi:10.1001/jama.2017.10572 CrossrefMedlineGoogle Scholar10. George M, Baker J, Chen L, et al. Provider variability in glucocorticoid prescribing for patients with rheumatoid arthritis and impact on chronic glucocorticoid use [Abstract]. Arthritis Rheumatol. 2019;71 Suppl 10. Google Scholar Author, Article, and Disclosure InformationAffiliations: Center for Clinical Management Research at VA Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at Michigan Medicine, Ann Arbor, Michigan (B.I.W., A.K.W.)Grant Support: Dr. Wallace's effort during the composition of this manuscript was supported by grant 5-KL2-TR002241-04 from the National Institutes of Health.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4234.Corresponding Author: Beth I. Wallace, MD, MSc, Michigan Medicine, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI 48109-5422; e-mail, [email protected]edu.Current Author Addresses: Dr. Wallace: Michigan Medicine, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI 48109-5422.Dr. Waljee: VA Ann Arbor Healthcare System, 2215 Fuller Road, Gastroenterology 111D, Ann Arbor, MI 48105.This article was published at Annals.org on 7 July 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation Between Oral Corticosteroid Bursts and Severe Adverse Events Tsung-Chieh Yao , Ya-Wen Huang , Sheng-Mao Chang , Shun-Yu Tsai , Ann Chen Wu , and Hui-Ju Tsai Metrics Cited byReview of evidence supporting the use of nasal corticosteroid irrigation for chronic rhinosinusitisThe Association Between Nonsteroidal Anti-Inflammatory Drug Use and Inflammatory Bowel Disease Exacerbations: A True Association or Residual Bias?Overuse of Oral Corticosteroids in Asthma Is Often Underdiagnosed and Inadequately AddressedAssociation of Oral Corticosteroid Bursts With Severe Adverse Events in ChildrenPrevalence of Immunosuppressive Drug Use Among Commercially Insured US Adults, 2018-2019Oral Corticosteroid Use in Asthma: A Wolf in Sheep's ClothingOral corticosteroid bursts increase risk of severe AEs 1 September 2020Volume 173, Issue 5Page: 390-391KeywordsAntibioticsBronchitisHealth insuranceHeart failureHemorrhageOpiatesSepsisToxicityUpper respiratory tract infectionsVenous thromboembolism ePublished: 7 July 2020 Issue Published: 1 September 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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