Steroid-induced secondary immune deficiency

Area of Science:

• Immunology
• Pharmacology
• Clinical Medicine

Background:

• Oral corticosteroids (OCSs) are widely used clinically.
• OCSs are associated with adverse effects, including immunosuppression.
• Prolonged OCS use impacts immune cell populations and immunoglobulin levels.

Purpose of the Study:

• To review the effects of prolonged oral corticosteroid use on the immune system.
• To assess the impact on humoral immunity and vaccination response.
• To identify risks and mitigation strategies for infections in OCS-treated patients.

Main Methods:

• Literature review of studies on OCS effects on immune function.
• Analysis of data on CD4 lymphopenia and immunoglobulin levels (IgG, IgM, IgA).
• Examination of vaccination responses in patients on prolonged OCS therapy.

Main Results:

• Prolonged OCS use causes CD4 lymphopenia and decreased serum IgG.
• Circulating B cells, serum IgM, and IgA levels are minimally affected.
• Individuals on OCS may maintain humoral responses to vaccinations despite hypogammaglobulinemia.

Conclusions:

• OCS-induced immunosuppression increases the risk of opportunistic infections, particularly in immunocompromised individuals.
• Vaccination response in OCS users requires further investigation, especially concerning COVID-19.
• Risk mitigation includes limiting OCS dose/duration, vaccination, and prophylactic measures.