Article Text

Download PDFPDF
Extended report
Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis
  1. J N Hoes1,
  2. J W G Jacobs1,
  3. S M M Verstappen1,
  4. J W J Bijlsma1,
  5. G J M G Van der Heijden2
  1. 1
    University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands
  2. 2
    University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
  1. Correspondence to Dr J W G Jacobs, University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, P O Box 85500, 3508 GA Utrecht, The Netherlands; j.w.g.jacobs{at}


Objectives: To systematically analyse the literature on reported adverse events of low- to medium-dose glucocorticoids during ⩾1 month for inflammatory diseases.

Methods: Data were systematically retrieved and selected from PUBMED, EMBASE and CINAHL databases (6097 hits).

Results: A total of 28 studies (2382 patients) met the inclusion criteria. The risk of adverse events over all studies was 150 per 100 patient-years (95% confidence interval (CI) 132 to 169). Psychological and behavioural adverse events (eg, minor mood disturbances) were most frequently reported, followed by gastrointestinal events (eg, dyspepsia, dysphagia). In 14 studies comprising 796 patients with rheumatoid arthritis the risk of adverse events was 43/100 patient-years (95% CI 30 to 55), in 4 studies of 167 patients with polymyalgia rheumatica the risk of adverse events was 80/100 patient-years (95% CI 15 to146), and in 10 studies of 1419 patients with inflammatory bowel disease the risk of adverse events was 555/100 patient-years (95% CI 391 to 718). High rates of adverse events were reported in high-quality studies with short follow-up, notably in studies of patients with inflammatory bowel disease.

Conclusions: The risk of adverse events depends on study design and disease. Studies on inflammatory bowel disease were often of short duration with frequent documentation of adverse events which resulted in higher adverse event rates whereas, in studies of rheumatoid arthritis, the longer follow-up may have resulted in lower adverse event rates. In most studies aimed at efficacy of glucocorticoids or other drugs, adverse events were not systematically assessed. Clear guidelines on assessment of adverse events are lacking.

Statistics from


Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.