Bursting the Steroid Bubble: Short-term Use Has Its Consequences

Authors:
Irene Ruiz, PharmD
Kristine A. Parbuoni, PharmD, BCPPS

Reviewers:
Sandra Benavides Caballero, PharmD
Lea S. Eiland, PharmD, BCPS, BCPPS
Kimmy Nguyen, PharmD, BCACP, BC-ADM
Avni Patel, PharmD, BCACP, BCPS

Citation: Yao TC, Wang JY, Chang SM, et al. Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children. JAMA Pediatr. 2021;175(7):723-729.

The Problem

Short courses of corticosteroids, also known as “steroid bursts,” are frequently utilized in both pediatrics and adults; however, evidence supporting the safety of these bursts is lacking. Long-term use of oral corticosteroids is associated with a number of serious adverse effects in adults, including osteoporosis, adrenal insufficiency, gastrointestinal (GI) bleeding, ophthalmologic effects, and hyperlipidemia.¹ In children, long-term use of oral corticosteroids frequently causes weight gain, growth suppression, and Cushingoid features. ² Literature regarding the adverse effects associated with short-term (<14 days) systemic corticosteroids is limited, especially in children.  New evidence suggests that a steroid burst is not risk-free.