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Published on: June 16, 2020
Incidence of New Comorbidities After Steroid Use in Patients With Sarcoidosis: An International Cross-Sectional
Logan J Harper1, Robert P Baughman2, Elyse E Lower2
1Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH.
Background:
Oral corticosteroids (OCSs) are recommended as first-line therapy for sarcoidosis, yet limited data describe the risk of steroid-associated adverse effects in this population.
Research Question:
What are the short-term and long-term effects of OCS exposure in terms of developing steroid-related comorbidities in a multinational cohort with sarcoidosis?
Study Design And Methods:
An electronic questionnaire was codeveloped and translated by an international team of sarcoidosis experts and patients from the United States and Europe. We used inverse probability weighting to estimate the average treatment effect on the treated adjusted for markers of disease severity. Before data collection, we prespecified 2 primary outcomes: (1) development of 13 steroid-associated comorbidities and (2) total weight change. Outcomes were compared across patients with OCS exposure categorized as current, past, or never.
Results:
We collected self-reported questionnaires from 1,937 patients with sarcoidosis representing 34 countries. In weighted analyses, ever use of OCSs (current or past OCS use) was associated with development of 1.3 more comorbidities (95% CI, 0.8-1.9) compared with never using OCSs. Ever use of OCSs was associated with increased odds for the development of mood changes (OR, 2.1; 95% CI, 1.3-3.4), gastroesophageal reflux disease (OR, 2.3; 95% CI, 1.3-4.1), bruising (OR, 2.3; 95% CI, 1.3-4.1), osteoporosis (OR, 3.8; 95% CI, 1.8-8.1), hyperlipidemia (OR, 1.9; 95% CI, 1.04-3.5), infections (OR, 2.1; 95% CI, 1.1-4.0), and diabetes (OR, 2.7; 95% CI, 1.2-6.0). Ever use of OCSs was associated with 5.9 kg (95% CI, 3.8-8.0 kg) more net weight gain than never use. The effects of OCS use were more pronounced between ever and never OCS users and were similar between current and past OCS users.
Interpretation:
Ever use of OCSs was associated with multiple steroid-related comorbidities and weight gain in patients with sarcoidosis. Notably, adverse effects persisted even after OCS discontinuation.
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