Long-term side effects of glucocorticoids

ABSTRACT

Introduction: Glucocorticoids represent the standard therapy for reducing inflammation and immune activation in various diseases. However, as with any potent medication, they are not without side effects. Glucocorticoid-associated side effects may involve most major organ systems. Musculoskeletal, gastrointestinal, cardiovascular, endocrine, neuropsychiatric, dermatologic, ocular, and immunologic side effects are all possible.

Areas Covered: This article analyzes English-language literature and provides an update on the most recent literature regarding side effects of systemic glucocorticoid treatment.

Expert Opinion: The risk/benefit ratio of glucocorticoid therapy can be improved by proper use. Careful monitoring and using appropriate preventive strategies can potentially minimize side effects.

KEYWORDS:

• glucocorticoids
• immunosuppression
• side effects
• corticosteroids

Article highlights

• Glucocorticoid-associated side effects may be musculoskeletal, endocrine, gastrointestinal, neuropsychiatric, cardiovascular, dermatologic, ocular or immunologic in nature.

• The risk of osteonecrosis and osteoporosis usually occurs with high doses and prolonged treatment duration; however, they may also develop with short-term exposure.

• Glucocorticoid-induced myopathy is the most common type of drug-induced myopathy and is characterized by painless muscle weakness, atrophy and fatigue.

• Endocrine and metabolic side effects of glucocorticoids include glucocorticoid-induced hyperglycemia, dyslipidemia, weight gain, cushingoid features, adrenal suppression and growth suppression.

• Cardiovascular side effects include hypertension, coronary heart disease, ischemic heart disease, heart failure and even sudden death.

• Dermatologic side effects include skin atrophy, ecchymosis, erosions, striae, delayed wound healing, purpura, easy bruising, acne, hirsutism and hair loss.

• The most common ophthalmologic side effects are cataract and glaucoma.

• Neuropsychiatric symptoms such as minor mood changes, depression, euphoria, mood lability, irritability, akathisia and anxiety as well as cognitive impairment such as attention, concentration and memory deficit have been reported after treatment with corticosteroids. In rare cases, psychosis, dementia and delirium may occur.

• The risk/benefit ratio of corticosteroid therapy can be improved by proper use of corticosteroids.

This box summarizes key points contained in the article.

Declaration of Interest

S Foster has acted as consultant for Aldeyra Therapeutics, Bausch & Lomb Surgical, Inc, Eygate Pharma, Novartis, pSivida and Xoma. He has reached grants or has grants pending with Alcon, Aldeyra Therapeutics, Bausch & Lomb, Clearside Biomedical, Dompe Pharmaceutical, Eyegate Pharma, Icon, Novartis, pSivida, Santen and Xoma. He has also received payments for lectures including service on speaking bureaus from Alcon and Allergan. He owns stock or stock options in Eyegate Pharma. M Oray has received a postdoctoral fellowship grant from the Scientific and Technological Research Council of Turkey. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed