Can adverse effects of glucocorticoid therapy be prevented and treated?

Figures & data

Table 1. Glucocorticoid-related adverse effects which can be prevented or treated with medication.

Glucocorticoid-related adverse effect	Prevention possible	Treatment possible	Medication
Osteoporosis	+	+	Prevention: calcium, vitamin D, bisphosphonates Treatment: calcium, vitamin D, bisphosphonates, teriparatide, and denosumab^b
Gastric ulcer disease, in case of comedication with NSAIDs or other risk factors^a	+	+	Prevention and treatment: proton-pump inhibitors
Hypertension	−	+	Regular treatment
Diabetes mellitus	−	+	Regular treatment
Dyslipidemia	−	+	Regular treatment
Infections	Partly	+	Prevention: vaccination and patient instruction to seek medical help in early stage Treatment: antibiotics, antiviral, and antifungal agents
Neuropsychiatric effects	−	+	Regular treatment
Glaucoma	+	+	Prevention: regular treatment for increased intraocular pressure Treatment: regular treatment

+: prevention or treatment is possible; −: no prevention or treatment; NSAID: nonsteroidal anti-inflammatory drug.

^aRisk factors are age >65 years, history of peptic ulcer disease, high-dose NSAID therapy, and comedication with anticoagulants.

^bNot yet licensed for treatment of glucocorticoid-induced osteoporosis.

Figure 1. Glucocorticoids as well as inflammatory disease activity can have negative effects on bone mass, muscle mass, lipids, endothelium, glucose metabolism, infection risk, and pregnancy outcome. Since glucocorticoids are capable of effectively dampening the disease activity, the net effect of glucocorticoids is unclear. Reproduced from [8].

Firestein GS, Budd RC, Gabriel SE, et al. Chapter 60 “glucocorticoids”. In: Jacobs JW, editors. Kelley’s textbook of rheumatology. (9th ed). Philadelphia: Elsevier Saunders; 2013. p. 894–916.

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