Metabolic adverse events associated with systemic corticosteroid therapy-a systematic review and meta-analysis.
Metabolic adverse events associated with systemic corticosteroid therapy-a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2022-061476
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发表时间：
2022-12-22
期刊：
影响因子：
2.9
通讯作者：
Ambery, Philip
中科院分区：
文献类型：
--
作者：
Kulkarni, Spoorthy;Durham, Hannah;Glover, Luke;Ather, Osaid;Phillips, Veronica;Nemes, Szilard;Cousens, Leslie;Blomgran, Parmis;Ambery, Philip
评估已发表的随机对照试验（RCT）研究中报告的全身性皮质类固醇治疗（CST）新发或恶化的高血糖症、高血压、体重增加和高血脂症的风险。使用MEDLINE、EMBASE、科克伦图书馆、Web of Science和Scopus进行文献检索，检索关于系统性CST组RCT结果的已发表文章，并提供不良反应（AE）的数值数据。在≥17岁的患者或健康志愿者中报告了与全身性CST相关的高血糖、高血压、体重增加和高血脂症。偏倚风险工具、AE水平评估和关键研究特征。共筛选了5446篇文章，包括118项研究，152个系统性CST组（总参与者= 17113例，其中8569例参与者接受CST治疗）。研究中CST组高血糖的合并患病率为10%（95% CI 7%-14%），呼吸系统疾病的患病率最高，为22%（95% CI 9%-35%）。皮质类固醇治疗组中重度高血脂、高血压、体重增加和高血脂的合并患病率分别为5%（95% CI 2%至9%）、6%（95% CI 4%至8%）、13%（95% CI 8%至18%）、8%（95% CI 4%至17%）。如双盲安慰剂对照平行组研究中所述，CST与高血糖、高血压和体重增加显著相关：OR分别为2.13（95% CI 1.66至2.72）、1.68（95% CI 0.96至2.95）和5.20（95% CI 2.10至12.90）。静脉治疗的风险高于口服治疗：OR为2.39（95%CI 1.16 - 4.91）。主要研究和研究患者人群中AE定义和AE报告质量存在显著异质性。无法计算累积剂量效应对偶发AE的影响。全身性CST使用与代谢AE风险增加相关，这因疾病组和给药途径而异。CRD 42020161270。
To assess the risk of new-onset or worsening hyperglycaemia, hypertension, weight gain and hyperlipidaemia with systemic corticosteroid therapy (CST) as reported in published randomised control trial (RCT) studies. Literature search using MEDLINE, EMBASE, Cochrane library, Web of Science and Scopus Published articles on results of RCT with a systemic CST arm with numerical data presented on adverse effect (AE). Reports of hyperglycaemia, hypertension, weight gain and hyperlipidaemia associated with systemic CST in patients or healthy volunteer’s ≥17 years of age. Risk of bias tool, assessment at the level of AE and key study characteristics. A total of 5446 articles were screened to include 118 studies with 152 systemic CST arms (total participants=17 113 among which 8569 participants treated with CST). Pooled prevalence of hyperglycaemia in the CST arms within the studies was 10% (95% CI 7% to 14%), with the highest prevalence in respiratory illnesses at 22% (95% CI 9% to 35%). Pooled prevalence of severe hyperglycaemia, hypertension, weight gain and hyperlipidaemia within the corticosteroid arms was 5% (95% CI 2% to 9%), 6% (95% CI 4% to 8%), 13% (95% CI 8% to 18%), 8% (95% CI 4% to 17%), respectively. CST was significantly associated hyperglycaemia, hypertension and weight gain as noted in double-blinded placebo-controlled parallel-arms studies: OR of 2.13 (95% CI 1.66 to 2.72), 1.68 (95% CI 0.96 to 2.95) and 5.20 (95% CI 2.10 to 12.90), respectively. Intravenous therapy posed higher risk than oral therapy: OR of 2.39 (95% CI 1.16 to 4.91). There was significant heterogeneity in the AE definitions and quality of AE reporting in the primary studies and patient populations in the studies. The impact of cumulative dose effect on incidental AE could not be calculated. Systemic CST use is associated with increased risk of metabolic AEs, which differs for each disease group and route of administration. CRD42020161270.
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影响因子：
--
作者：
Alia, Inmaculada;de la Cal, Miguel A.;Anzueto, Antonio
通讯作者：
Anzueto, Antonio
影响因子：
5.8
作者：
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通讯作者：
von Arx, G.
DOI：
10.1016/j.jaip.2018.04.008
发表时间：
2018-11-01
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9.4
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通讯作者：
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27.4
作者：
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通讯作者：
Bijlsma, J. W. J.