Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review

Area of Science:

• Pharmacology and Therapeutics
• Health Economics
• Systematic Review and Meta-Analysis

Background:

• Corticosteroids are widely used but associated with significant toxicities.
• Prior reviews identified increased risks of costly adverse events (AEs) like fractures and infections.
• Long-term corticosteroid exposure poses a substantial burden on patients and healthcare systems.

Purpose of the Study:

• To systematically review recent literature on the burden of long-term corticosteroid exposure.
• To summarize the adverse events (AEs) and economic impact of prolonged corticosteroid use.
• To identify data gaps for future research directions.

Main Methods:

• Systematic literature search conducted on the Ovid platform (2007-2016).
• Included articles focused on corticosteroid use and economic outcomes, excluding pediatrics and conference abstracts.
• Reviewers screened titles/abstracts and extracted data from full-text articles.

Main Results:

• 32 articles were included, primarily on autoimmune and respiratory diseases.
• Common AEs: hypertension (>30%), bone fracture (21-30%), cataracts (1-3%), GI issues (1-5%), metabolic problems (4x risk).
• High-dose users incur significantly higher healthcare costs ($29,000/year vs. $5700 for low-dose).

Conclusions:

• Despite dose reductions, significant and costly AEs persist with long-term corticosteroid use.
• Current management strategies and adherence to guidelines for mitigating AEs are suboptimal.
• Further research is needed to address data gaps and explore alternative therapeutic options.