Adverse events of glucocorticoid pulse therapy in inflammatory diseases: a meta-analysis

Abstract

Objective To systematically analyse the literature on reported adverse events of high intravenous pulse glucocorticoids (≥250 mg prednisone equivalent) for inflammatory diseases and transplantation. Methods A literature search was done using PubMed, Embase, and Cochrane databases. Studies were selected by two reviewers (NAMS and ND). Available data on the prevalence of glucocorticoid-related adverse events (AEs) in patients with RA, systemic sclerosis, asthma, or organ transplantation were retrieved. Results 50 studies were included, of which 10 studies (451 patients) documented intravenous pulse glucocorticoids-related adverse events. In total, 438 AEs had been recorded, which resulted in an AE rate of 44/100 patient-years. Cardiovascular and infectious adverse events were the most frequent AEs. There were 4 placebo-controlled studies comprising of RA and systemic sclerosis patients, in which the odds ratio of flushing was highest, 14.69 (95% CI 5.34 to 40.46), followed by that of headache: 6.19 (95% CI 2.33 to 16.43). There was also a high risk of lower respiratory tract infection, disturbance of taste, and heart rhythm disorders. Conclusion Only relatively few studies are present in the literature that report on intravenous pulse glucocorticoid-related AEs. In RA patients, cardiovascular adverse events are frequently documented, and in systemic sclerosis patients and patient who had transplantation infectious adverse events are predominantly present.