NHRI researcher reports association of oral corticosteroid bursts with severe adverse events in children

It has been known that long-term use of oral corticosteroids (OCS) is associated with subsequent adverse health events. However, few studies have reported the risk of corticosteroid bursts (defined as the use of OCS for 14 or fewer days) in children. Dr. Hui-Ju Tsai from the Institutes of Population Health Sciences and her collaborators at the Chang Gung Memorial Hospital, National Cheng Kung University and Children’s Hospital at Boston, employed a self-controlled case series design and conducted a nationwide population-based study in Taiwan to evaluate the association of corticosteroid bursts in children with 4 adverse events (GI bleeding, sepsis, pneumonia, and glaucoma) using data derived from the National Health Insurance Research Database (NHIRD).

A total of 4,542,623 children younger than 18 years of age were identified from the NHIRD from January 1, 2013, to December 31, 2017. Among those, 1,897,858 (42%) received at least 1 corticosteroid burst during the 5-year study period to treat mostly acute respiratory tract infections (34%) and allergic diseases (31%). Incidence rates of the 4 severe adverse events were calculated in children who did or did not receive corticosteroid bursts. Conditional fixed-effect Poisson regression was used to estimate incidence rate ratios (IRRs) of severe adverse events within 5 to 30 days and 31 to 90 days after initiation of corticosteroid bursts. The team found corticosteroid bursts were significantly associated with a 1.4- to 2.2-fold increase of GI bleeding, sepsis, and pneumonia, but not glaucoma, within the first month after initiation of corticosteroid therapy.

Dr. Tsai and colleagues’ findings suggested clinicians should consider rare but potentially serious adverse events associated with use of corticosteroid bursts among children, particularly during the first month after corticosteroid initiation. These findings provide real-world evidence for clinicians and guideline developers to implement strategies with optimal benefit to risk ratios for preventing avoidable harms from the use of corticosteroid bursts for children.

Citation: Yao, TC; Wang, JY; Chang, SM; Chang, YC; Tsai, YF; Wu, AC; Huang, JL; Tsai, HJ. Association of oral corticosteroid bursts with severe adverse events in children. JAMA Pediatrics. 2021 Apr 19;Article in Press.

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