Corticosteroids may increase risk for hospitalization for sickle cell disease pain crises
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Exposure to systemic corticosteroids appeared to increase risk for hospitalization for vaso-occlusive episodes among patients with sickle cell disease, according to a French study published in Blood.
Those most likely to be hospitalized included older adults, women and patients not treated with hydroxyurea, researchers wrote.
“Based on these results, we still need to think twice about using corticosteroids when treating patients with [sickle cell disease],” Ondine Walter, MD, of Toulouse University Hospital in France, said in a press release.
Background, methodology
Patients with sickle cell disease experience recurrent vaso-occlusive episodes (VOEs), or pain crises, that can substantially impair quality of life, Walter said. Corticosteroids are widely prescribed for these patients; however, systemic corticosteroid exposure has been suspected — based on case reports and series — of increasing VOE occurrences, according to researchers.
Walter and colleagues assessed the association of corticosteroid exposure and hospitalization for VOEs among 5,151 patients with sickle cell disease (median age at first VOE, 16.9 years; 53.9% women) in the French National Health Insurance Database from 2010 to 2018. All patients had at least one hospitalization for a VOE.
Researchers identified corticosteroid exposure through outpatient prescribing data and used a case-case-time-control study design, which induced self-adjustment for time-dependent confounders such as infections and red blood cell transfusions, and stratified by hydroxyurea exposure, they wrote.
First hospitalization for a VOE identified during the study period served as the outcome.
Results
Results showed a significant association of corticosteroid exposure with hospitalization for VOEs (adjusted OR [aOR] = 3.8; 95% CI, 2.4-5.6). Those exposed to hydroxyurea had lower risk for hospitalization (aOR = 2.6; 95% CI, 1.1-6.4) than those not exposed to the drug (aOR = 4; 95% CI, 2.5-6.3). Researchers also observed lower risk among men (aOR = 2.1; 95% CI, 1.1-4) vs. women (aOR = 6.5; 95% CI, 3.5-12.3) and among children (aOR = 2.8; 95% CI, 1.5-5.3) vs. adults (aOR = 4.5; 95% CI, 2.4-8.4).
Limitations included the inability to prove causation or confirm that patients took the medication.
Implications
ASH clinical practice guidelines advise against use of corticosteroids for acute pain management of patients with sickle cell disease. The current study reinforces research that indicates corticosteroids should be administered only when needed, according to researchers.
“Corticosteroids are mostly easy to avoid, and in circumstances when they are necessary, it’s important to start them in collaboration with [a sickle cell disease] expert and to take all appropriate precautionary measures to administer them safely,” Walter said in the release.
References:
Corticosteroids raise the risk of hospitalization for pain crises among individuals living with sickle cell disease (press release). www.hematology.org/newsroom/press-releases. Published April 26, 2022. Accessed April 26, 2022.
Walter O, et al. Blood. 2022;doi:10.1182/blood.2021014473.
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