Fardet Laurence, Kassar Abdulrhaman, Cabane Jean, Flahault Antoine
Department of Internal Medicine, Hôpital Saint Antoine, Paris, France.
Drug Saf. 2007;30(10):861-81. doi: 10.2165/00002018-200730100-00005.
Corticosteroids represent the most important and frequently used class of anti-inflammatory drugs and are the reference therapy for numerous neoplastic, immunological and allergic diseases. However, their substantial efficacy is often counter-balanced by multiple adverse events. These corticosteroid-induced adverse events represent a broad clinical and biological spectrum from mild irritability to severe and life-threatening adrenal insufficiency or cardiovascular events. The purpose of this article is to provide an overview of the available data regarding the frequency, screening and prevention of the adverse events observed in adults during systemic corticosteroid therapy (topically administered corticosteroids are outside the remit of this review). These include clinical (i.e. adipose tissue redistribution, hypertension, cardiovascular risk, osteoporosis, myopathy, peptic ulcer, adrenal insufficiency, infections, mood disorders, ophthalmological disorders, skin disorders, menstrual disorders, aseptic necrosis, pancreatitis) and biological (i.e. electrolytes homeostasis, diabetogenesis, dyslipidaemia) events. Lastly, data about the prescription of corticosteroids during pregnancy are provided. This review underscores the absence of data on many of these adverse events (e.g. lipodystrophy, dyslipidaemia). Our intent is to present to practitioners data that can be used in a practical way to both screen and prevent most of the adverse events observed during systemic corticosteroid therapy.
皮质类固醇是最重要且最常用的一类抗炎药物，是众多肿瘤、免疫和过敏性疾病的参考治疗药物。然而，它们的显著疗效常常被多种不良事件所抵消。这些皮质类固醇诱导的不良事件涵盖了广泛的临床和生物学范围，从轻度易怒到严重且危及生命的肾上腺功能不全或心血管事件。本文的目的是概述有关全身皮质类固醇治疗期间（局部应用皮质类固醇不在本综述范围内）成人中观察到的不良事件的发生频率、筛查和预防的现有数据。这些不良事件包括临床方面的（即脂肪组织重新分布、高血压、心血管风险、骨质疏松症、肌病、消化性溃疡、肾上腺功能不全、感染、情绪障碍、眼科疾病、皮肤疾病、月经紊乱、无菌性坏死、胰腺炎）和生物学方面的（即电解质稳态、糖尿病发生、血脂异常）事件。最后，提供了关于孕期皮质类固醇处方的数据。本综述强调了许多这些不良事件（如脂肪营养不良、血脂异常）缺乏相关数据。我们的目的是向从业者提供可实际用于筛查和预防全身皮质类固醇治疗期间观察到的大多数不良事件的数据。
