From the Journals

Corticosteroids may raise risk of sickle cell pain crisis


NEW YORK (Reuters) – Corticosteroids may raise the risk of painful vaso-occlusive episodes requiring hospitalization in people with sickle cell disease (SCD), with older adults, women and patients not taking hydroxyurea most at risk, according to a new study.

“Vaso-occlusive events and related hospitalization appear to follow corticosteroid prescription fairly quickly. This evidence suggests corticosteroids may be contributing to the events and should be avoided as much as possible in these patients,” Dr. Ondine Walter of Toulouse University Hospital, in France, said in a news release from the American Society of Hematology.

Corticosteroids are often prescribed for asthma and other conditions unrelated to SCD and are “mostly easy to avoid,” she said. “In circumstances when they are necessary, it’s important to start them in collaboration with an SCD expert and to take all appropriate precautionary measures to administer them safely.”

Using a French healthcare database, Dr. Walter and her colleagues assessed the risk of hospitalization for vaso-occlusive episodes (VOE) associated with corticosteroid use in 5,151 patients with SCD and at least one hospital admission for VOE.

Patients exposed to a corticosteroid in the month leading up to the event were significantly more likely to be hospitalized for VOE (adjusted odds ratio, 3.8), the researchers report in Blood.

Patients taking hydroxyurea seemed to have less risk of VOE hospitalization compared with peers not taking hydroxyurea (aOR, 2.6 vs. 4.0).

Risk was also lower among men than women (aOR, 2.1 vs. 6.5) and among children than adults (aOR, 2.8 vs. 4.5).

Based on these results, it’s appropriate to “think twice about using corticosteroids when treating patients with SCD,” said Dr. Walter.

Current guidelines from the American Society of Hematology advise against use of corticosteroids for acute pain management in patients with SCD.

Reuters Health Information © 2022

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