Children Face Added Risks With Corticosteroid Use

Children who take oral corticosteroids for autoimmune conditions, such as juvenile arthritis, psoriasis, inflammatory bowel disease or other conditions, like asthma, have an increased risk of diabetes, high blood pressure, and blood clots, say researchers writing in the American Journal of Epidemiology.

The study, led by Daniel B. Horton, M.D., of Rutgers University, is based on a review of more than 933,000 pediatric cases.

“The rates of diabetes, high blood pressure and blood clots from oral steroids have been studied in large populations of adults. However, there are reasons to think these findings might be different in children who not only tend to take steroids differently than adults, but also have much lower baseline risks of developing these same cardiovascular and metabolic conditions. This study allowed us to put numbers on the association between oral steroids and rare, but potentially serious, complications in children,” Dr. Horton said in a news release.

The researchers found that children who were receiving high doses of corticosteroids experienced diabetes, high blood pressure and blood clots at much higher rates than children who took lower doses or who had a history of taking corticosteroids. High pressure was the most common side effect.

“While children receiving high-dose steroids were at substantially higher risk for developing diabetes, high blood pressure or blood clots relative to children not taking these medicines, the absolute risks of these complications were still small. The vast majority of children taking brief courses of steroids for conditions such as asthma, for instance, will not experience these complications,” Dr. Horton said.

Adverse events associated with the chronic use of corticosteroids, or taking them in high doses, have been well-documented. In fact, alternative options have been explored. Writing in Best Practice and Research, Clinical Rheumatology, authors Ethan Sen and A.V. Ramanan review treatments for juvenile idiopathic arthritis-associated uveitis and write that early treatment with biologics may negate the need for corticosteroid therapy.

"There is increasing evidence for the early introduction of systemic immunosuppressive therapies to reduce topical and systemic use of glucocorticoids. A recently published randomized controlled trial of adalimumab in JIA-associated uveitis now provides convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and abatacept are being investigated as alternatives in children inadequately treated with anti-tumor necrosis factor drugs," they wrote.

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