Steroids are bad for you. Lifesavingly so.

Dexamethasone_structureThere are two newish articles on steroids in the Archives – one is a systematic review of adverse drug reactions (ADRs) from short-course use, and one the initial creation of a quality of life tool intended to be used to look at how steroids, particularly dexamathasone, affect the life of those children and young people who get it.

It’s reminded me that steroids are really quite bad for you. But lifesaving too.

Quick poll then: which of these are common (>5%) side effects of short course steroids?

And it’s also identified that when academic clinicians put studies together and start collecting Outcomes Of Interest, we don’t always collect what Outcomes Of Interest for the folk who’ll be in the trial are. For example, the QoL tool development paper shows major areas affected by steroids; behavioural change, weight gain & appearance changes, appetite changes, mood, cognition and attention effects, and the ensuing problems caused for families and relationships. The ADR review, which collects the ADR that have been reported by the original studies, found data on nausea and vomiting, disturbed behaviour, sleep problems, appetite, abdominal pain and GI disturbance, serious infection, blood pressure and pituitary axis suppression. The steroid-AE teams seem to have missed out on cognitive, mood and family effects; the QoL doesn’t seem affected too much by blood pressure measurements and infections.

To really think about how we put information about medications across to patients, we’ll need to have information from all angles, the way patients and young people experience medicines, the way we know they alter significant clinical outcomes, and the way they interact with all the other medicines they are on.

Course, this would also be a perfect opportunity to re-consider the blog we wrote a while ago on choosing outcomes wisely… and a quick look at the ADR paper of course to see the right answers to the poll.

– ArchiDexamethasone_structure

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