Adverse events related to low dose corticosteroids in autoimmune hepatitis

the Dutch Autoimmune Hepatitis Study Group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases. Aim: To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis. Methods: We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results: A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25%) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions: Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.
Original languageEnglish
Pages (from-to)1120-1126
JournalAlimentary Pharmacology and Therapeutics
Volume50
Issue number10
DOIs
Publication statusPublished - 1 Nov 2019

Cite this

the Dutch Autoimmune Hepatitis Study Group. / Adverse events related to low dose corticosteroids in autoimmune hepatitis. In: Alimentary Pharmacology and Therapeutics. 2019 ; Vol. 50, No. 10. pp. 1120-1126.
@article{e5b01fa3dcb048f7acd15e754cf868cc,
title = "Adverse events related to low dose corticosteroids in autoimmune hepatitis",
abstract = "Background: Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases. Aim: To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis. Methods: We retrospectively collected data on 476 patients (77{\%} women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results: A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25{\%}) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions: Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.",
author = "{van den Brand}, {Floris F.} and {van der Veen}, {Koen S.} and Lissenberg-Witte, {Birgit I.} and {de Boer}, {Ynto S.} and {van Hoek}, Bart and Drenth, {Joost P. H.} and Verdonk, {Robert C.} and Vrolijk, {Jan M.} and {van Nieuwkerk}, {Carin M. J.} and Gerd Bouma and {the Dutch Autoimmune Hepatitis Study Group} and {van Gerven}, {N. M.} and Kuijvenhoven, {J. Ph.} and Schreuder, {T. C. M. A.} and {van der Wouden}, {E. J.} and {van Meyel}, {J. J. M.} and Baak, {L. C.} and Stadhouders, {P. H. G. M.} and M. Klemt-Kropp and Verhagen, {M. A. M. T.} and A. Bhalla and {den Ouden}, {J. W.} and U. Beuers and {van Erpecum}, {K. J.} and {van Buuren}, {H. R.} and Brouwer, {J. T.}",
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language = "English",
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pages = "1120--1126",
journal = "Alimentary Pharmacology and Therapeutics",
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Adverse events related to low dose corticosteroids in autoimmune hepatitis. / the Dutch Autoimmune Hepatitis Study Group.

In: Alimentary Pharmacology and Therapeutics, Vol. 50, No. 10, 01.11.2019, p. 1120-1126.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Adverse events related to low dose corticosteroids in autoimmune hepatitis

AU - van den Brand, Floris F.

AU - van der Veen, Koen S.

AU - Lissenberg-Witte, Birgit I.

AU - de Boer, Ynto S.

AU - van Hoek, Bart

AU - Drenth, Joost P. H.

AU - Verdonk, Robert C.

AU - Vrolijk, Jan M.

AU - van Nieuwkerk, Carin M. J.

AU - Bouma, Gerd

AU - the Dutch Autoimmune Hepatitis Study Group

AU - van Gerven, N. M.

AU - Kuijvenhoven, J. Ph.

AU - Schreuder, T. C. M. A.

AU - van der Wouden, E. J.

AU - van Meyel, J. J. M.

AU - Baak, L. C.

AU - Stadhouders, P. H. G. M.

AU - Klemt-Kropp, M.

AU - Verhagen, M. A. M. T.

AU - Bhalla, A.

AU - den Ouden, J. W.

AU - Beuers, U.

AU - van Erpecum, K. J.

AU - van Buuren, H. R.

AU - Brouwer, J. T.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases. Aim: To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis. Methods: We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results: A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25%) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions: Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.

AB - Background: Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases. Aim: To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis. Methods: We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results: A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25%) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions: Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31617229

U2 - 10.1111/apt.15528

DO - 10.1111/apt.15528

M3 - Article

VL - 50

SP - 1120

EP - 1126

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 10

ER -