Steroids: no clear evidence in causing gastric ulcers.

Clinical bottom line (level 1a)

  1. The commonest steroid side effects are: Cushing's syndrome (NNH = 12 at unknown) , bacterial sepsis (NNH = 110 at unknown) , hypertension (NNH = 350 at unknown) , dyspepsia symptoms (NNH = 440 at unknown) and diabetes mellitus (NNH = 450 at unknown) .
  2. Osteoporosis, psychosis and ulcers were not clearly associated with steroids.
Conn and Poynard: Journal of Internal Medicine 1994; 236: 619-632
Expires February 2001

The study

Systematic review of double blind, randomised controlled trials of
  • Patients: any medical condition
  • Intervention: corticosteroid hormones compared with placebo
  • Outcome: adverse effects


    • Articles found in ? language using MEDLARS, 1964 to 1982 (search terms: clinical trials, corticotrophin, cortisone, dexamethasone, hydrocortisone, methylprednisolone, paramethasone, prednisolone, prednisone, triamcinolone, adrenal cortex ) and handsearch of Quarterly Cumulative Index Medicus using the terms: therapy, adrenal cortex preparations, hormones and the individual hormones. Bibliographic review and contacting authors.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: abstracts admitted to national medical meetings, letters and non-peer reviewed articles

    93 trials involving 6602 patients were included.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNH
    (95% CI)
    symptoms of peptic ulcer unknown 7/2778
    (0.25%)    		 1.90
    (1.10 to 3.00)     		440
    (200 to 4000)
    Cushing's syndrome/acne/hirsutism unknown 76/2890
    (2.63%)    		 4.50
    (3.50 to 5.70)     		12
    (9 to 17)
    bacterial sepsis unknown 132/2776
    (4.76%)    		 1.20
    (1.00 to 1.60)     		110
    (38 to -)
    diabetes mellitus unknown 11/3449
    (0.32%)    		 1.70
    (1.10 to 2.60)     		450
    (200 to 3100)
    osteoporosis unknown 1/722
    (0.14%)    		 1.70
    (0.70 to 4.10)     		1000
    (NNT = 2400 to infinity;
    NNH = 230 to infinity)
    hypertension unknown 7/2941
    (0.24%)    		 2.20
    (1.40 to 3.80)     		350
    (150 to 1100)
    psychosis unknown 10/3321
    (0.30%)    		 1.30
    (0.80 to 2.10)     		1100
    (NNT = 1700 to infinity;
    NNH = 300 to infinity)
    tuberculosis unknown 0/2042
    (0.00%)    		 1.30
    (0.70 to 2.20)
    ulcer unknown 9/3267
    (0.28%)    		 1.30
    (0.80 to 2.10)     		1200
    (NNT = 1800 to infinity;
    NNH = 330 to infinity)
    haemorrhage from ulcer unknown 1/3175
    (0.03%)    		 1.20
    (0.70 to 2.20)     		17000
    (NNT = 11000 to infinity;
    NNH = 2800 to infinity)
    perforation unknown 0/3267
    (0.00%)    		 1.00
    (0.50 to 1.90)
    death from ulcer unknown 1/3267
    (0.03%)
    ( to )

    • Mean dose of prednisone was 35 mg or equivalent, for a mean of 64 days.

    Comments

    1. Few patients with osteoporosis studied- very low rates compared with cohort studies. Difficult to draw conclusions about rare events.

    Citation

    1. Conn HO, and Poynard T: Corticosteroids and peptic ulcer: a meta-analysis of adverse events during steroid therapy. Journal of Internal Medicine 1994; 236: 619-632
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient any medical disorder
    Intervention or Exposure corticosteroid hormone
    Comparison placebo
    Outcome adverse effects