Use Of Systemic Glucocorticoids Research Articles

Systemic Glucocorticoids Are Associated With Mortality After Carotid Endarterectomy.

Glucocorticoids (GCs) are widely used anti-inflammatory drugs well known to cause many adverse effects. Still, there is a dearth of data on the long-term cardiovascular effects of GCs in patients with established cardiovascular disease and the effect on atherosclerotic plaque composition. A total of 1894 patients who underwent carotid endarterectomy (CEA), of whom 40 patients received systemic GCs, were included in the Athero-Express Biobank. Atherosclerotic plaque samples and peripheral blood samples were obtained during CEA. Cardiovascular events during 3 years of follow-up were investigated using Cox regression modeling to adjust for possible confounding. Atherosclerotic plaque composition was examined using immunohistochemical staining. Use of GCs at inclusion was associated with markedly increased incidences of ischemic stroke (15.2% vs. 5.9%), composite events (48.5% vs. 26.9%), and cardiovascular death (21.2% vs. 5.7%), as well as an increased risk of cardiovascular death (hazards ratio 2.7, 95% confidence interval, 1.1-6.7) and all-cause death (hazards ratio 2.3, 95% confidence interval, 1.1-4.8) after 2.6 years of follow-up. None of the histological features of atherosclerotic plaques were significantly different in patients using GCs. After CEA, the use of systemic GCs is independently associated with an increased incidence of cardiovascular events and an increased risk of cardiovascular and all-cause death, but not atherosclerotic plaque composition.

Chronic rhinosinusitis management beyond intranasal steroids and saline solution irrigations.

Chronic rhinosinusitis (CRS) is a heterogeneous disease with clinical manifestations that are influenced by the presence or absence of nasal polyposis. Understanding of the current and future treatment modalities for CRS is essential in preventing exacerbation and morbidity associated with this chronic condition. The aim of this article is to review the evidence behind current medical therapies and potential new treatments for CRS. Scientific literature regarding intranasal and systemic antibiotics, intranasal systemic corticosteroids, and monoclonal antibodies as interventions for CRS with and without nasal polyps was reviewed. The literature supports the use of topical or systemic glucocorticoids in patients with nasal polyps, and there appears to be a role for systemic antibiotics in the treatment of acute exacerbations of CRS with nasal polyps. The response to corticosteroids or antibiotics in the treatment of exacerbations of CRS without nasal polyps is variable. Due to the lack of appropriately designed trials, there is weak evidence for the adjunctive use of immunotherapy at this time. Monoclonal antibodies that target Immunoglobulin E and T helper cell 2 cytokines have been clinically effective in symptom reduction for some patients with CRS with nasal polyps although further studies are needed. Current therapies used in the treatment of CRS are discussed.

Factors associated with type-specific persistence of high-risk human papillomavirus infection: A population-based study.

Persistent genital infection with high-risk (HR) human papillomavirus (HPV) is a prerequisite for cervical cancer development. The aim of this study was to identify factors associated with type-specific persistence of HR HPV infections. From a population-based cohort of 40,399 women participating in cervical cancer screening established during 2002-2005, we selected all HR HPV-positive women (N = 7,778). During follow-up (2005-2008), we collected cervical samples from these women and tested them for HPV DNA to determine type-specific HR HPV persistence in the interval 1-4.5 years after enrolment. Data on hospitalisations, prescriptions and socioeconomic factors were obtained from nationwide registers. Women with abnormal cytology at baseline or who had undergone conisation during follow-up were excluded. Factors associated with persistence were identified by logistic regression analysis. The overall rate of HR HPV persistence was 31.4%. The risk for persistence was significantly increased among women with a previous episode of genital warts (OR, 1.35; 95% CI, 1.04-1.74), current use of oral contraceptives (OR, 1.35; 95% CI, 1.13-1.63) or use of systemic glucocorticoids (OR, 2.04; 95% CI, 1.16-3.56). The number of pregnancies or births or use of a hormonal intrauterine device, hormonal therapy or nonsteroidal anti-inflammatory drugs was not associated with risk for HR HPV persistence. A history of genital warts and current use of oral contraceptives or systemic glucocorticoids increased the risk, potentially indicating a decreased immune response to HPV infection. These findings suggest that host immune response characteristics are important in HR HPV persistence and consequently in cervical cancer development.

Vital to monitor, prevent and treat metabolic and cardiovascular adverse events induced by long-term systemic glucocorticoid therapy

Given the potentially severe consequences of the metabolic and cardiovascular adverse events often induced by the long-term use of systemic glucocorticoids, it is essential that patients receive adequate screening, preventative care and treatment. However, as data are currently limited and largely inconclusive, medical consensus and optimal management strategies have yet to be established; further study is needed.

Neutrophil-to-lymphocyte ratio, calprotectin and YKL-40 in patients with chronic obstructive pulmonary disease: correlations and 5-year mortality - a cohort study.

BackgroundChronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation and progressive decline in pulmonary function. Neutrophil-to-lymphocyte ratio (NLR), YKL-40 and calprotectin are biomarkers of inflammation and predict mortality in patients with different inflammatory diseases. We aimed to investigate the correlation between levels of these three biomarkers and neutrophil granulocyte and lymphocyte count in patients with moderate to very severe COPD stratified by use of systemic glucocorticoids. Furthermore, we studied the ability of these biomarkers to predict all-cause mortality.Methods386 patients with moderate to very severe COPD were followed prospectively for 10 years. Patients were divided into two groups according to systemic glucocorticoid use at baseline. Correlations between biomarkers were assessed by Spearman’s Rho, and mortality was evaluated in uni- and multivariate Cox regression analyses with hazard ratios (HR) and 95% confidence intervals (CI).ResultsPlasma calprotectin was positively correlated with neutrophil granulocyte count and NLR. No significant association was found between plasma YKL-40 and the cellular biomarkers, irrespective of glucocorticoid treatment. In the group not treated with systemic glucocorticoids, plasma calprotectin [HR 1.002 (95% CI 1.000 – 1.004)], NLR [HR 1.090 (1.036 – 1.148)] and lymphocyte count [HR 0.667 (0.522 – 0.851)] were significantly associated with higher mortality. In the group treated with systemic glucocorticoids, higher plasma YKL-40 was significantly associated with mortality in univariate Cox regression analysis [HR 1.006 (1.003 – 1.008)].ConclusionsCalprotectin was related to neutrophil granulocyte count and NLR in patients with moderate to very severe COPD in stable phase and not in treatment with systemic glucocorticoids. Lymphopenia, higher plasma calprotectin and higher NLR were independent predictors of increased all-cause mortality in this group. Our data also suggests that treatment with systemic glucocorticoids has a significant impact on the ability of inflammatory biomarkers to predict all-cause mortality.Trial registrationClinicalTrials.gov NCT00132860.

Severe hypersensitivity reaction to anti-tuberculosis drugs DRESSed as an infectious disease: What can be done to improve awareness?

Severe hypersensitivity reaction to anti-tuberculosis drugs DRESSed as an infectious disease: What can be done to improve awareness?

Oral Glucocorticoid-Sparing Effect of Mepolizumab in Eosinophilic Asthma

BackgroundMany patients with severe asthma require regular treatment with oral glucocorticoids despite the use of high-dose inhaled therapy. However, the regular use of systemic glucocorticoids can result in serious and often irreversible adverse effects. Mepolizumab, a humanized monoclonal antibody that binds to and inactivates interleukin-5, has been shown to reduce asthma exacerbations in patients with severe eosinophilic asthma.MethodsIn a randomized, double-blind trial involving 135 patients with severe eosinophilic asthma, we compared the glucocorticoid-sparing effect of mepolizumab (at a dose of 100 mg) with that of placebo administered subcutaneously every 4 weeks for 20 weeks. The primary outcome was the degree of reduction in the glucocorticoid dose (90 to 100% reduction, 75 to less than 90% reduction, 50 to less than 75% reduction, more than 0 to less than 50% reduction, or no decrease in oral glucocorticoid dose, a lack of asthma control during weeks 20 to 24, or withdrawal from treatment). Other outcomes included the rate of asthma exacerbations, asthma control, and safety.ResultsThe likelihood of a reduction in the glucocorticoid-dose stratum was 2.39 times greater in the mepolizumab group than in the placebo group (95% confidence interval, 1.25 to 4.56; P=0.008). The median percentage reduction from baseline in the glucocorticoid dose was 50% in the mepolizumab group, as compared with no reduction in the placebo group (P=0.007). Despite receiving a reduced glucocorticoid dose, patients in the mepolizumab group, as compared with those in the placebo group, had a relative reduction of 32% in the annualized rate of exacerbations (1.44 vs. 2.12, P=0.04) and a reduction of 0.52 points with respect to asthma symptoms (P=0.004), as measured on the Asthma Control Questionnaire 5 (in which the minimal clinically important difference is 0.5 points). The safety profile of mepolizumab was similar to that of placebo.ConclusionsIn patients requiring daily oral glucocorticoid therapy to maintain asthma control, mepolizumab had a significant glucocorticoid-sparing effect, reduced exacerbations, and improved control of asthma symptoms. (Funded by GlaxoSmithKline; SIRIUS ClinicalTrials.gov number, NCT01691508.)

Systemic glucocorticoid use and early-onset basal cell carcinoma

Immunosuppressive medications are common in the management of numerous conditions, such as organ transplantation, allergies, and respiratory disorders [1]. In some patients with conditions, such as organ transplantation, that require long-term, high-dose immunosuppression, immunosuppressives increase risk for squamous cell carcinoma of the skin (SCC) (60–250 fold increase), and to a lesser extent for basal cell carcinoma (BCC) (10 fold increase) [2–10]. An increased risk of non-melanoma skin cancer (NMSC) has also been associated with immunosuppressives among rheumatoid arthritis and inflammatory bowel disease patients [11–13]. With widespread use of low-potency, low-dose immunosuppressives, particularly glucocorticoids, for allergic and inflammatory conditions, there is interest in whether these low-level exposures increase NMSC risk. Glucocorticoids and NMSC have been evaluated in three studies [14–17]. A US case-control study found a two-fold increased risk of SCC with oral glucocorticoids, but only a suggestive non-significant association for BCC [16]. A Danish cohort study using national prescription data found a 16% increase in BCC with injected or oral glucocorticoids, with greater risk with more prescriptions [17]. A case-control study in the same Danish population found a 15% increase in BCC with oral glucocorticoids and increased risk with longer duration [15]. There was one positive [17] and one null finding [15] for SCC in the Danish studies. Finally, a US prospective study found no association between oral prednisone and BCC or SCC in adults with prior NMSC [14]. While short-term steroid use is not known to have any lasting impact on immune function, transient immune suppression from systemic steroid use could impact BCC risk, especially in those with high ultraviolet radiation exposure, which may itself induce local immune suppression [18]. To address the paucity of research on systemic glucocorticoids and NMSC, we evaluated this relationship in a case-control study of early-onset BCC.

Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register

BackgroundTreatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.ObjectiveTo evaluate trends in prescription patterns of biological agents and the subsequent outcome of...

Glucocorticoids.

Glucocorticoids are the most effective anti-inflammatory treatment for allergic diseases, and inhaled glucocorticoids have now become the first-line treatment for asthma. Glucocorticoids were discovered in the 1940s as extracts of the adrenal cortex and this was followed by the isolation of adrenocorticotropic hormone (ACTH) from pituitary gland extracts. Cortisone and ACTH were found to be very beneficial in the treatment of rheumatoid arthritis and Kendall, Reichstein and Hench received the Nobel Prize in Physiology and Medicine for this work in 1950. Bordley and colleagues first showed that ACTH was very beneficial in the treatment of allergic diseases in 1949, but the use of systemic glucocorticoids was limited by side effects. Inhaled glucocorticoids were discovered from topical steroids developed for skin inflammation and beclomethasone dipropionate was introduced in 1972, initially in low doses but later in higher doses, and became the standard treatment for persistent asthma. Subsequently, inhaled glucocorticoids were combined with long-acting β2-agonists in combination inhalers for even greater therapeutic benefit. There is now a good understanding of the molecular basis for the anti-inflammatory effects of glucocorticoids in allergic diseases. The search for even safer glucocorticoids based on the dissociation of anti-inflammatory and side effect mechanisms is currently ongoing.

Sa1122 Anti-TNF-Therapy in Patients With an Early Course of CrohnS Disease - A Prospective Observational Study in Germany

Background: The nationwide BioCrohn Registry (Biological Registry with Crohǹs Disease Patients in Germany) of the German Competence-Network IBD is a five-year prospective registry of patients suffering from Crohn's disease (CD) in Germany. Up to October 2012, about 1.450 patients were included by 57 different gastroenterology practices and hospitals with IBD-experience. This 24 months follow-up interim analysis reports in particular the anti-TNF data of 638 early disease CD-patients. Methods: Within the framework of this non-interventional prospective online documentation, data on the course of disease, on psychosocial disease burden, on health economics and on the genetic profile will be examined. Until the end of 2012 the registry aims at including 1.500 patients with 5 years of followup. Results: 638 early disease CD-patients (course of disease: , 3 years) were analyzed (average age: 33 years; female: 55%). The following therapies were observed. The use of immunosuppressants and/or anti-TNF increased from 74.4% (6 months), to 79.4% (12 months) and to 82.8% after two years, resp. (35.3% with anti-TNF after 24 months). Accordingly, the use of systemic glucocorticoids dropped over time (baseline until 6, 12, 18 and 24 months) from 24.9% to 8.1%, 7.9%, 5.9% and 2.5%, respectively (p ,0.001). The remission rate (PGA) was 72.4% after 12 months and 73.2% after 24 months, CRP normalized over the time (baseline: 9.2 mg/l, 24 months: 4.3 mg/l). CD-patients with an anti-TNF therapy within the first 12 months after baseline (n=88; time since first diagnosis 1.4 years) experienced a relatively favourable course by use of the anti-TNF therapy despite their complex disease (24 months: 63.3% in remission and HBI 2.5). Additionally, this subgroup showed a trend towards decreasing use of azathioprine (baseline: 31.6% and 24 months 26.7%) and a significant decrease in active smoking (32% at baseline and only 14% after 24 months). Conclusion: These 24 months real life setting follow-up data show that the group of early disease CD-patients suffer from a large burden of disease and improve considerably with the relatively early escalation of therapy as suggested by current CDguidelines in IBD-experienced centres with only minor usage of systemic glucocorticoids in the maintenance therapy. Especially the early disease CD-patients with anti-TNF-therapy show a relatively favourable course in spite of their complex disease.

Sa1123 The Risk of Colorectal Cancer Following a Negative Colonoscopy: A Comparison of Different Follow-up Colonoscopy Intervals

Background: The nationwide BioCrohn Registry (Biological Registry with Crohǹs Disease Patients in Germany) of the German Competence-Network IBD is a five-year prospective registry of patients suffering from Crohn's disease (CD) in Germany. Up to October 2012, about 1.450 patients were included by 57 different gastroenterology practices and hospitals with IBD-experience. This 24 months follow-up interim analysis reports in particular the anti-TNF data of 638 early disease CD-patients. Methods: Within the framework of this non-interventional prospective online documentation, data on the course of disease, on psychosocial disease burden, on health economics and on the genetic profile will be examined. Until the end of 2012 the registry aims at including 1.500 patients with 5 years of followup. Results: 638 early disease CD-patients (course of disease: , 3 years) were analyzed (average age: 33 years; female: 55%). The following therapies were observed. The use of immunosuppressants and/or anti-TNF increased from 74.4% (6 months), to 79.4% (12 months) and to 82.8% after two years, resp. (35.3% with anti-TNF after 24 months). Accordingly, the use of systemic glucocorticoids dropped over time (baseline until 6, 12, 18 and 24 months) from 24.9% to 8.1%, 7.9%, 5.9% and 2.5%, respectively (p ,0.001). The remission rate (PGA) was 72.4% after 12 months and 73.2% after 24 months, CRP normalized over the time (baseline: 9.2 mg/l, 24 months: 4.3 mg/l). CD-patients with an anti-TNF therapy within the first 12 months after baseline (n=88; time since first diagnosis 1.4 years) experienced a relatively favourable course by use of the anti-TNF therapy despite their complex disease (24 months: 63.3% in remission and HBI 2.5). Additionally, this subgroup showed a trend towards decreasing use of azathioprine (baseline: 31.6% and 24 months 26.7%) and a significant decrease in active smoking (32% at baseline and only 14% after 24 months). Conclusion: These 24 months real life setting follow-up data show that the group of early disease CD-patients suffer from a large burden of disease and improve considerably with the relatively early escalation of therapy as suggested by current CDguidelines in IBD-experienced centres with only minor usage of systemic glucocorticoids in the maintenance therapy. Especially the early disease CD-patients with anti-TNF-therapy show a relatively favourable course in spite of their complex disease.

Causes, mechanisms and management of paediatric osteoporosis

Osteoporosis, a skeletal disorder characterized by compromised bone strength and an increased risk of fractures, is an important paediatric disorder that involves almost all paediatric subspecialties. Osteogenesis imperfecta is the most common form of childhood-onset primary osteoporosis, but several other forms are also known. Secondary osteoporosis is caused by an underlying chronic illness or its treatment. The most common causes of secondary osteoporosis include chronic systemic inflammation, glucocorticoid use and neuromuscular disabilities. The skeletal sequelae can present in childhood as low-energy peripheral and vertebral fractures, or become evident in adulthood as low bone mass and an increased propensity to develop osteoporosis. Management should aim at prevention, as interventions to treat symptomatic osteoporosis in the paediatric age group are scarce. Bisphosphonates are the principal pharmacological agents that can be used in this setting, but data on their efficacy and safety in paediatric populations remain inadequate, especially in patients with secondary osteoporosis. Consequently, it is important to understand the potential skeletal effects of paediatric illnesses and their therapies in order to institute effective and timely prevention of skeletal complications.

Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study

Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged durations of exposure were particularly associated with adverse events-dose information did not improve risk prediction. Systemic glucocorticoid use, defined as ever having taken supra-physiologic doses for 90-days or more, is a risk factor for low BMD and fractures. This definition does not distinguish recent (vs remote) exposure. Within a population-based clinical BMD registry in Manitoba, Canada, we identified all adults over age 40 years tested between 1998 and 2007 and then undertook a cohort study. We identified all oral glucocorticoid dispensations from 1995 to 2009 and stratified exposure by timing ("recent" if within 12 months vs "remote") and duration (short [<90 days] vs prolonged [≥90 days]). Osteoporosis-related risk factors and treatments and major fractures were obtained using administrative health data. A total of 12,818 of 52,070 (25%) subjects had used glucocorticoids prior to BMD testing; the most common exposure was remote short (n = 6453) vs recent prolonged (n = 2896) vs recent short (n = 2644) vs remote prolonged (n = 825). Compared to 39,252 never-users, only recent prolonged glucocorticoid use was significantly associated with femoral neck T-score (ANCOVA-adjusted difference -0.13, 95% CI -0.16 to -0.10, p < 0.001). There were 2,842 major (566 hip) fractures over median 5-year follow-up. Compared with never-users, only recent prolonged glucocorticoid use was significantly associated with BMD-independent increases in risk of incident major fracture (5.4 vs 7.7%, adjusted HR 1.25, 95% CI 1.07-1.45, p = 0.004) and hip fracture (1.1 vs 1.8%, adjusted HR 1.61, 95% CI 1.18-2.20, p = 0.003). Recent and prolonged glucocorticoid use (but neither remote nor recent short courses) was independently associated with reduced BMD and increased risk of fractures. These findings should permit clinicians to identify a high-risk group of patients that might benefit from osteoporosis prevention.

Effect of Inhaled Corticosteroids (ICS) Vs. Inhaled Corticosteroid with Long-Acting Beta2 Agonists (ICS/LABA) On Asthma Control: Results From National Asthma Survey

There is limited evidence for the comparative efficacy of ICS vs. ICS/LABA to treat asthma in children under 12 years. Data from the 2003 National Asthma Survey were analyzed to compare asthma control in children (5 to 11 yrs) using ICS vs. ICS/LABA. Both short term (symptoms within last 2 weeks, day and night symptoms in last 30 days and use of systemic glucocorticoids in last 3 months) and long term (asthma exacerbation, emergency department visits, hospitalizations and activity limitations in the prior year) outcomes were compared. Demographics, availability of health insurance, indoor allergen exposure and asthma education were compared between the two groups. Asthma control in adult (18 to 44 years) and older population (>=65 years) was also assessed for the same parameters. 134 children on ICS and 69 on ICS/LABA were identified. Baseline characteristics were similar in both groups. There were no differences in short and long term asthma outcomes between the two groups (p>0.05 for all outcome measures). Similar results were obtained with the adult and older population (p>0.05 for all outcome measures). ICS/LABA was used for more than 6 months in 58% of children, 81% of adults and 46% of the older population. Asthma control in children using ICS vs. ICS/LABA was similar. So was asthma control using similar medications in the adult and older populations. LABA tolerance or the use of ICS/LABA in subjects with more severe asthma could explain these findings.

A Randomized, Double-Blind, Placebo-Controlled, Multiple-Dose Study to Evaluate the Safety, Tolerability, and Efficacy of Brodalumab (AMG 827) in Subjects with Moderate to Severe Asthma

T U E S D A Y 816 Effect of Inhaled Corticosteroids (ICS) Vs. Inhaled Corticosteroid with Long-Acting Beta2 Agonists (ICS/LABA) On Asthma Control: Results From National Asthma Survey Neetu Talreja, MD, Dennis K. Ledford, MD, FAAAAI, Richard F. Lockey, MD; Morsani College of Medicine University of South Florida and James A. Haley Veteran Hospital. RATIONALE: There is limited evidence for the comparative efficacy of ICS vs. ICS/LABA to treat asthma in children under 12 years. METHODS: Data from the 2003 National Asthma Survey were analyzed to compare asthma control in children (5 to 11 yrs) using ICS vs. ICS/LABA. Both short term (symptoms within last 2 weeks, day and night symptoms in last 30 days and use of systemic glucocorticoids in last 3 months) and long term (asthma exacerbation, emergency department visits, hospitalizations and activity limitations in the prior year) outcomes were compared. Demographics, availability of health insurance, indoor allergen exposure and asthma education were compared between the two groups. Asthma control in adult (18 to 44 years) and older population (>565 years) was also assessed for the same parameters. RESULTS: 134 children on ICS and 69 on ICS/LABA were identified. Baseline characteristics were similar in both groups. There were no differences in short and long term asthma outcomes between the two groups (p>0.05 for all outcome measures). Similar results were obtained with the adult and older population (p>0.05 for all outcome measures). ICS/LABAwas used for more than 6 months in 58% of children, 81% of adults and 46% of the older population. CONCLUSIONS: Asthma control in children using ICS vs. ICS/LABA was similar. So was asthma control using similar medications in the adult and older populations. LABA tolerance or the use of ICS/LABA in subjects with more severe asthma could explain these findings.

Asthma diagnosis and treatment – 1018. Effect of inhaled corticosteroids with long-acting beta2 agonists vs. inhaled corticosteroids alone on asthma control in children: results from national ashtma survey

Methods Data from the National Asthma Survey were analyzed to compare asthma control in children (5 to 11 yrs) using ICS/LABA vs. ICS alone. Both short term (symptoms within last 2 weeks, day and night symptoms in last 30 days and use of systemic glucocorticoids in last 3 months) and long term (asthma attack, emergency department visits, hospitalizations and activity limitations in the prior year) outcomes were compared. Demographics, availability of health insurance, indoor allergen exposure and asthma education were compared between the two groups. Asthma control in an adult population (18 to 44 years) was also assessed for the same parameters.

The safe and appropriate use of systemic glucocorticoids in treating dermatologic disease

The safe and appropriate use of systemic glucocorticoids in treating dermatologic disease

Risk assessment of fragility fracture: NICE guideline

Fragility fractures result from mechanical forces that would not ordinarily result in fracture. The World Health Organization (WHO) has quantified this as forces equivalent to a fall from a standing height or less. Reduced bone density is a major risk factor for fragility fractures. The prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years. There are a number of pharmacological treatments available for the primary or secondary prevention of fragility fractures. These primarily target bone loss and assessment for treatment has largely been based on the measurement of bone mineral density (BMD). However, the majority of fragility fractures occur in people who do not have osteoporosis. Factors, including lifestyle factors such as smoking and high alcohol intake, the use of oral or systemic glucocorticoids, sex, previous fractures, and disorders such as rheumatoid arthritis all increase the risk of fragility fracture. This new guideline from NICE assesses the value of risk prediction tools, with and without BMD, for prediction of fracture risk.1 The guideline …

Use of systemic glucocorticoids and the risk of colorectal cancer

Systemic glucocorticoids are potent immunosuppressants, potentially facilitating carcinogenesis. Studies examining glucocorticoids and colorectal cancer risk are few. To investigate the association between use of systemic glucocorticoids and colorectal cancer risk, both overall and by cancer stage (localised versus metastatic). We conducted a nested population-based case-control study in Northern Denmark (1.8 million people) using medical registries. The study included 14,158 patients with a first-time diagnosis of colorectal cancer from 1991 through 2010. Using risk set sampling, we identified 141,580 population controls, matched on age and gender. Logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for covariates. Frequent use of systemic glucocorticoids (defined as >2 prescriptions) was not associated with overall colorectal cancer risk [adjusted OR (aOR) = 0.93 (95% CI: 0.85-1.00)], compared with never/rare use (≤2 prescriptions). Associations according to duration of use and doses (quartiles of cumulative prednisolone equivalents) were also near the null. Examining colorectal cancer by stage, no substantial associations were found between long-term use (>5 years) of high-dose (>5500 mg) systemic glucocorticoids and localised [aOR = 1.12 (95% CI: 0.81-1.55)] or metastatic [aOR = 0.82 (95% CI: 0.59-1.14)] cancer. Despite immunological and metabolic effects of frequent use of systemic glucocorticoids, which would be expected to increase colorectal cancer risk, we found no substantial association between the two.