Oral glucocorticoids pose increased hazard of cardiometabolic diseases in kids

Children taking high-dose oral glucocorticoids are at high risk of developing venous thromboembolism (VTE), diabetes, and hypertension, although the absolute risks are small, a study has found.

Researchers looked at a retrospective cohort involving 932,517 children diagnosed with autoimmune diseases (inflammatory bowel disease, juvenile idiopathic arthritis, or psoriasis) or a nonimmune comparator condition (attention-deficit/hyperactivity disorder). Of the children, 198,855 (21.3 percent) were glucocorticoid-exposed. Follow-up time was 1.6 million person-years.

Compared with unexposed kids, those who were glucocorticoid-exposed tended to be younger and have longer follow-up time, higher rates of prior oral glucocorticoid and nonsteroidal anti-inflammatory (NSAID) exposure, lower stimulant use, and higher levels of healthcare usage.

Crude incidence rates were lowest for VTE (unexposed vs exposed: 0.5 vs 15.6 per million person-days) and highest for hypertension (unexposed vs exposed: 6.7 vs 74.4 per million person-days). On the other hand, absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases than in those with attention-deficit/hyperactivity disorder.

In multivariable Cox regression models, current glucocorticoid exposure showed strong dose-dependent associations with all outcomes: diabetes (high-dose: adjusted hazard ratio [aHR], 5.93, 95 percent confidence intervals [CI], 3.94–8.91), hypertension (aHR, 19.13, 95 percent CI, 15.43–23.73), and VTE (aHR, 16.16, 95 percent CI, 8.94–29.22).

The findings indicate that while there is a safety signal detected, all reported treatment complications are uncommon in children, according to the researchers.