Long term side effects from prednisone

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Long-Term Side Effects of Prednisone: A Comprehensive Review

Introduction to Prednisone and Its Uses

Prednisone is a corticosteroid widely used to treat various inflammatory and autoimmune conditions, including myasthenia gravis (MG), Crohn's disease, kidney transplantation, pemphigus, and autoimmune hepatitis. Despite its efficacy, long-term use of prednisone is associated with numerous side effects that can significantly impact patients' quality of life.

Common Long-Term Side Effects of Prednisone

Weight Gain and Increased Appetite

One of the most frequently reported side effects of long-term prednisone use is weight gain, often accompanied by an increased appetite. In a study involving MG patients, 63% reported weight gain as a side effect, with 38% finding it intolerable . This side effect is particularly concerning as it can lead to obesity and related health issues.

Cardiovascular and Metabolic Effects

Long-term prednisone use is associated with several cardiovascular and metabolic side effects, including hypertension, hypercholesterolemia, and diabetes. A study on kidney transplant patients found that discontinuing prednisone reduced the need for antihypertensive and cholesterol-lowering drugs and decreased the incidence of type II diabetes . Another study on pemphigus patients reported a high incidence of diabetes and endocrine disorders among those treated with prednisone alone .

Bone and Muscle Disorders

Prednisone can lead to bone and muscle disorders such as osteoporosis, myopathy, and avascular necrosis. In the study on pemphigus, bone disorders were common among patients treated with prednisone . Additionally, a study on kidney transplant patients noted a significant reduction in cataracts and avascular necrosis with rapid discontinuation of prednisone .

Infections and Immune Suppression

Long-term prednisone therapy can suppress the immune system, increasing the risk of infections. In the National Cooperative Crohn's Disease Study, a substantial number of patients on high-dose prednisone required dose reduction or withdrawal due to side effects, including infections . Similarly, kidney transplant patients who discontinued prednisone had a lower incidence of infections .

Psychological and Dermatological Effects

Psychological effects such as insomnia and mood swings are also common with long-term prednisone use. In a study comparing prednisone and dexamethasone for immune thrombocytopenia, patients on prednisone experienced more infectious complications, while those on dexamethasone reported more insomnia . Dermatological issues like acne and moonface were also noted in various studies .

Mitigating Long-Term Side Effects

Alternative Therapies and Tapering Strategies

To mitigate the long-term side effects of prednisone, alternative therapies and tapering strategies are often employed. For instance, combining prednisone with other immunosuppressive drugs like azathioprine or cyclosporine can allow for lower doses of prednisone, reducing side effects Hollander1997Joly2017. Additionally, rapid discontinuation protocols have shown promise in minimizing side effects while maintaining efficacy .

Monitoring and Supportive Care

Regular monitoring and supportive care are crucial for patients on long-term prednisone therapy. This includes routine checks for blood pressure, blood sugar levels, and bone density, as well as providing dietary and lifestyle advice to manage weight gain and other metabolic effects.

Conclusion

While prednisone is an effective treatment for many inflammatory and autoimmune conditions, its long-term use is associated with a range of side effects that can significantly impact patients' health and quality of life. Weight gain, cardiovascular and metabolic issues, bone and muscle disorders, infections, and psychological effects are among the most common long-term side effects. Employing alternative therapies, tapering strategies, and regular monitoring can help mitigate these adverse effects, ensuring better patient outcomes.

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Most relevant research papers on this topic

Prednisone Side Effects are Common and Associated with Unwillingness to Accept a Dose Increase: Survey Result from MGFA Registry (P6.443)

Prednisone use in myasthenia gravis is common, but variable dosage and dosing frequencies lead to intolerable side effects, particularly weight gain, which often hinder treatment acceptance.

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·Ikjae Lee et al.

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DOI

National Cooperative Crohn's Disease Study: adverse reactions to study drugs.

Sulfasalazine is the safest and most effective suppressive drug for Crohn's disease, with prednisone showing substantial toxicity but acceptable suppressive efficacy, and azathioprine showing similar toxicity but no more effective than placebo in suppressing active disease.

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1979·

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·J. Singleton et al.

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Late prednisone withdrawal in cyclosporine-treated kidney transplant patients: a randomized study.

Prednisone withdrawal after kidney transplantation can be safely achieved, leading to reduced hypertension, hypercholesterolemia, hyperglycemia, and improved appearance.

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·A. Hollander et al.

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First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial.

First-line rituximab combined with short-term prednisone significantly improves the proportion of patients achieving complete remission off-therapy in pemphigus patients, while decreasing treatment side-effects.

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·P. Joly et al.

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Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation.

Rapid discontinuation of prednisone after kidney transplantation can minimize steroid-related side effects and maintain acceptable 10-year patient and graft outcomes.

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78citations

·M. Rizzari et al.

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A Randomized Trial of Daily Prednisone versus Pulsed Dexamethasone in Treatment-Naïve Adult Patients with Immune Thrombocytopenia: EIS 2002 Study

Pulsed dexamethasone is a more effective first-line treatment for immune thrombocytopenia than daily prednisone, with longer remission duration and lower side effects.

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·J. Matschke et al.

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Prednisone side-effects and serum-protein levels. A collaborative study.

Hypoalbuminaemia increases free prednisolone levels in the body, partly explaining the increased frequency of side-effects in patients receiving prednisone.

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207citations

·G. Lewis et al.

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Budesonide induces remission more effectively than prednisone in a controlled trial of patients with autoimmune hepatitis.

Oral budesonide, combined with azathioprine, effectively induces and maintains remission in noncirrhotic autoimmune hepatitis patients, with a low rate of steroid-specific side effects.

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·M. Manns et al.

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Prednisone therapy for alopecia areata. A follow-up report.

Alternate-day prednisone therapy for alopecia areata is not recommended for long-term use due to potential serious side effects and lack of substantial improvement in the condition's course.

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·R. Winter et al.

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Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children

Long-course prednisone therapy for the initial attack of steroid-responsive nephrotic syndrome in children reduces relapse rates without increasing the risk for severe side-effects.

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1993·

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·J. Ehrich et al.

European Journal of Pediatrics·

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