Revisiting the safety of short-term systemic corticosteroids

Short-term systemic corticosteroids are widely prescribed to treat acute flare-ups of chronic immunologic diseases or to manage acute inflammatory conditions such as allergic reactions, skin disorders, and respiratory infections. This review revisits the safety of short-term systemic corticosteroids, focusing on emerging evidence of their potential unexpected risks. Epidemiological studies reveal an increasing trend in prescribing of short-term systemic corticosteroids in the general population. However, concerns have been raised regarding the safety of short-term oral corticosteroids, with recent evidence suggesting that even corticosteroid bursts are associated with rare but serious adverse events, including sepsis, pneumonia, gastrointestinal bleeding, acute pancreatitis, heart failure, venous thromboembolism, and fracture. Recent studies also highlight long-term risks of antenatal corticosteroids. While crucial for reducing neonatal respiratory distress syndrome in pregnancies at risk of preterm delivery, antenatal corticosteroids are linked to long-term risks of neuropsychiatric disorders, serious infections, and even mortality in children, along with heightened risks of infections, heart failure, and gastrointestinal bleeding among mothers. These findings suggest the potential harms of short-term systemic corticosteroids may have been previously underrecognized. Raising awareness of these risks can help clinicians balance therapeutic benefits against potential harms and promote safer clinical practice. Cautious and evidence-based approaches to prescribing short-term systemic corticosteroids are necessary, particularly in vulnerable populations. Further research is needed to develop a "corticosteroid stewardship" approach that promotes appropriate prescribing of systemic corticosteroids, minimizes unnecessary use, and ensures careful monitoring of adverse effects to optimize patient outcomes.