Prednisone long term side effects
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Long-Term Side Effects of Prednisone
Introduction to Prednisone and Its Uses
Prednisone is a corticosteroid commonly prescribed for a variety of conditions, including autoimmune diseases, inflammatory disorders, and as part of immunosuppressive therapy post-transplantation. While effective, its long-term use is associated with a range of side effects that can significantly impact patient 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 myasthenia gravis patients, 63% reported weight gain, with 38% finding it intolerable 1. This side effect is particularly concerning as it can lead to obesity and related health issues.
Cardiovascular Risks: Hypertension and Hypercholesterolemia
Long-term prednisone use is associated with increased cardiovascular risks, including hypertension and hypercholesterolemia. A study on kidney transplant patients found that those who discontinued prednisone had a lower need for antihypertensive and cholesterol-lowering medications 3. This suggests that prolonged prednisone use can exacerbate these conditions.
Diabetes and Hyperglycemia
Prednisone can induce hyperglycemia and increase the risk of developing Type II diabetes. In kidney transplant patients, discontinuation of prednisone led to a reduction in the incidence of new-onset diabetes and lower levels of glycosylated hemoglobin 3. This highlights the significant impact of prednisone on glucose metabolism.
Bone and Muscle Disorders
Long-term prednisone therapy is linked to bone disorders such as osteoporosis and avascular necrosis. In a study comparing prednisone with rituximab for pemphigus treatment, bone disorders were more common in the prednisone-alone group 4. Additionally, muscle weakness and myopathy are notable side effects, as seen in patients with Duchenne muscular dystrophy 910.
Infections and Immune Suppression
Prednisone's immunosuppressive properties increase the risk of infections. In a study on Crohn's disease, a significant number of patients on high-dose prednisone required dose reduction or withdrawal due to side effects, including infections 2. Similarly, kidney transplant patients who discontinued prednisone had a lower incidence of infections 3.
Dermatological and Cosmetic Effects
Cosmetic side effects such as cushingoid appearance (moon face) and excessive hair growth are common with long-term prednisone use. These effects were notably observed in patients with Duchenne muscular dystrophy and other conditions requiring prolonged corticosteroid therapy 910.
Psychological and Neurological Effects
Long-term prednisone use can also lead to psychological effects such as mood swings, insomnia, and even severe psychiatric conditions. In a study comparing prednisone with dexamethasone for immune thrombocytopenia, patients on prednisone experienced more infectious complications, which can indirectly affect mental health 6.
Conclusion
While prednisone is an effective treatment for many conditions, its long-term use is fraught with significant side effects. These include weight gain, cardiovascular risks, diabetes, bone and muscle disorders, increased infection risk, and various cosmetic and psychological effects. Careful management and monitoring are essential to mitigate these risks and improve patient outcomes. Further research is needed to develop guidelines for safer long-term use of prednisone.
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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.
Observational Study
Very Rigorous JournalNational 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.
Observational Study
Highly CitedLate 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.
RCTHighly CitedFirst-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.
RCT
Rigorous JournalHighly CitedPrednisone 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.
Observational StudyHighly CitedA 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.
RCTTen-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.
Observational StudyHighly CitedBudesonide 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.
RCTHighly CitedRandomized, double-blind six-month trial of prednisone in Duchenne's muscular dystrophy.
Prednisone improves strength and function in Duchenne's muscular dystrophy patients, but further research is needed to identify the mechanisms and determine if prolonged treatment is warranted despite side effects.
RCTHighly CitedLong‐term benefit from prednisone therapy in Duchenne muscular dystrophy
Prednisone treatment significantly slows the progression of weakness and loss of function in boys with Duchenne muscular dystrophy for at least 3 years.
RCTHighly Cited