Corticosteroid-induced clinical adverse events: frequency, risk factors and patient's opinion

[Functional manifestations associated to corticosteroid therapy among the elderly]

PURPOSE

Corticosteroid therapy is frequently prescribed in the elderly with potentially significant consequences in this frail population. The objective of this study was to describe the functional manifestations associated and the preventive measures prescribed with corticosteroid therapy among patients over 75 years old.

PATIENTS AND METHODS

We conducted an exposed/non-exposed, prospective, multi-centre, observational study. Each exposed patient was sex and age (± 2 years) matched to two unexposed subjects. The sample included patients aged over 75 years treated with long-term corticosteroid therapy and hospitalized in an acute geriatric unit between June 2006 and November 2009. Sociodemographic and geriatric characteristics, history of corticosteroid therapy, clinical manifestations and preventive measures prescribed were collected.

RESULTS

Fifty exposed and 100 unexposed patients were included. Mean age was 85±6 years. Prevalence of falls, osteoarticular complications, amyotrophy, vertebral fractures, lipodystrophy, purpura, hematomas and cataracts, and the number of medications were higher among patients taking corticosteroid therapy than in controls. Preventive measures were more often prescribed to patients under taking corticosteroid therapy (calcium and vitamin supplementation, potassium supplementation, anti-osteoporosis medication and gastroprotective agents).

CONCLUSION

Functional manifestations associated with corticosteroid therapy are frequent among the elderly and may have serious consequences in this frail population. Attention should be paid to the prescription of preventive measures through comprehensive care.

Characteristics and outcome of immune thrombocytopenia in elderly: results from a single center case-controlled study

The management of ITP in elderly raises several questions that have not been fully addressed in the literature. To assess the impact of ITP in elderly, a case-control study was performed. The main characteristics at onset and the outcome of ITP in 55 patients aged of 70 years and above (cases) were compared with those of 97 younger adults (controls) seen at the same tertiary referral institution. The mean age at diagnosis was respectively 77.8±6.1 years (cases) and 40.3±14.9 years (controls). While the median platelet count at time of diagnosis was not significantly different in cases and controls (6×10(9) /L, range: 2-26 versus 12×10(9) /L: 5-21.5), bleeding symptoms were more frequent in cases (82%) than in the controls (68%, p=0.07), and the median bleeding score was significantly higher in elderly (p=0.001). The rate of treatment-related adverse events was more than twofold higher in elderly patients and the mean cumulative duration of hospital stay for ITP during the follow-up period was much longer when compared to the controls (p<0.0001). Three ITP-related deaths (5.4%) including 1 from intracranial hemorrhage occurred in the cases but none in the controls. In conclusion, this study confirms that at equivalent platelet count, ITP has a greater impact in elderly.

Delirium in Palliative Care Patients: Focus on Pharmacotherapy

Patients receiving palliative care often possess multiple risk factors and predisposing conditions for delirium. The impact of delirium on patient care in this population may also be far-reaching: affecting not only quality of remaining life but the dying process experienced by patients, caregivers, and the medical team as well. As palliative care focuses on comfort and symptom management, the approach to assessment and subsequent treatment of delirium in palliative care patients may prove difficult for providers to navigate. This article summarizes the multifactorial nature, numerous predisposing medical risk factors, neuropsychiatric adverse effects of palliative medications, pharmacokinetic changes, and challenges complicating delirium assessment and provides a systematic framework for assessment. The benefits, risks, and patient-specific considerations for treatment selection are also discussed.

Prevalence of long-term oral glucocorticoid prescriptions in the UK over the past 20 years

OBJECTIVE

To assess trends in long-term (i.e. ≥3 months) oral glucocorticoid (GC) prescriptions over the past 20 years.

METHODS

Data of UK adult patients registered between January 1989 and December 2008 with general practices contributing to The Health Improvement Network (THIN) database were obtained. The annual prevalence of long-term oral GC prescriptions was assessed in the whole population and specifically in people with RA, PMR/GCA, asthma, chronic obstructive pulmonary disease (COPD), Crohn's disease and ulcerative colitis (UC). Trends over the 20-year period were estimated using sex- and age-adjusted Poisson regression models.

RESULTS

During the 26 035 154 person-years of follow-up, an average of 0.75% (95% CI 0.74, 0.75) of the study population was prescribed long-term oral GC therapy at any time point. This rose from 0.59% (0.52, 0.67) in 1989 to 0.79% (0.78, 0.80) in 2008. Long-term prescriptions significantly increased in patients with RA [from 10.3% (8.7, 11.9) to 13.6% (12.9, 14.2)] and PMR/GCA [from 57.6% (53.3, 62.0) to 66.5% (65.2, 67.7)], decreased in patients with asthma, COPD and Crohn's disease and remained stable in patients with UC. However, when only incident cases were considered, we found a decreased use of GCs in patients with RA and UC [odds ratio 0.97 (95% CI 0.96, 0.97) and 0.94 (95% CI 0.93, 0.96) per increasing year, respectively].

CONCLUSION

Over the past 20 years, long-term oral GC prescriptions have increased by 34%. Patients newly diagnosed with RA, Crohn's disease or UC are, however, less likely to receive long-term GC prescriptions than patients with a long past medical history of the disease, suggesting changes in physicians' practice.

Impact of glucocorticoid-induced adverse events on adherence in patients receiving long-term systemic glucocorticoid therapy

BACKGROUND

Factors influencing adherence to long-term (i.e. ≥ 3 months) systemic glucocorticoid therapy are poorly understood.

OBJECTIVE

To evaluate the relationship between glucocorticoid-induced adverse events and therapeutic adherence in patients on long-term glucocorticoid treatment.

METHODS

A cross-sectional survey was conducted in three departments of dermatology/internal medicine between April and September 2008. Patients were asked to provide data regarding symptoms they attributed to glucocorticoids, and adherence to treatment was measured using the four-item Morisky-Green adherence scale. Logistic regression analyses were used to assess the association between reported adverse events and adherence to glucocorticoids.

RESULTS

A total of 255 questionnaires were completed and analysed [women 78%; median age 48 years (interquartile range (IQR) 34-65); connective tissue diseases 59%; median duration of treatment 24 months (IQR 8-72); median daily dose 10 mg (IQR 6-20)]. Among these 255 patients, 199 (78%) reported themselves as 'good adherents' and 56 (22%) as 'poor adherents' to treatment. Poor adherence was associated with younger age [odds ratio (OR) 0·97, 95% confidence interval (CI) 0·95-0·99, per increasing year; P < 0·01], presence of glucocorticoid-induced epigastralgia (OR 4·02, 95% CI 2·00-8·09; P < 0·01) and presence of glucocorticoid-induced morphological changes (OR 2·49, 95% CI 1·19-5·21; P = 0·02). Moreover, patients with poor adherence were likely to report concomitantly poor adherence to dietary advice associated with glucocorticoid therapy (OR 2·44, 95% CI 1·12-5·26; P = 0·02).

CONCLUSIONS

As with other chronic therapies, the presence of glucocorticoid-induced adverse events is associated with an altered self-reported adherence to glucocorticoids. Patients who report epigastric pain or morphological changes that they associate with glucocorticoid therapy are particularly at risk of poor adherence. Adherence to dietary advice associated with glucocorticoid therapy may be an indirect measure of treatment adherence.

Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management

While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship. This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset. There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease. The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions. There is evidence, however, that the course of the disease is worse in depressed patients. Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms. The second part of the review focuses on patient management issues for those with comorbid anxiety or depression. Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease. We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient.

Foreign body granulomas after all injectable dermal fillers: part 2. Treatment options

SUMMARY

Foreign body granulomas occur at certain rates with all injectable dermal fillers. They have to be distinguished from early implant nodules, which usually appear 2 to 4 weeks after injection. In general, foreign body granulomas appear after a latent period of several months at all injected sites at the same time. If diagnosed early and treated correctly, they can be diminished within a few weeks. The treatment of choice of this hyperactive granulation tissue is the intralesional injection of corticosteroid crystals (triamcinolone, betamethasone, or prednisolone), which may be repeated in 4-week cycles until the right dose is found. To lower the risk of skin atrophy, corticosteroids can be combined with antimitotic drugs such as 5-fluorouracil and pulsed lasers. Because foreign body granulomas grow fingerlike into the surrounding tissue, surgical excision should be the last option. Surgery or drainage is indicated to treat normal lumps and cystic foreign body granulomas with little tissue ingrowth. In most patients, a foreign body granuloma is a single event during a lifetime, often triggered by a systemic bacterial infection.

[Short-term effect of dietary-sodium intake on arterial blood pressure of patients treated with systemic corticosteroids: a prospective, randomised, crossover study]

INTRODUCTION

It is unknown if the level of dietary-sodium intake influences blood pressure in patients receiving systemic corticosteroids.

METHODS

Randomized, single centre, crossover trial involving patients starting systemic corticosteroid therapy and having initial blood pressure less or equals to 159/99 mm Hg. The first period of sodium regimen was randomized (<3 g/j versus >6 g/j) and each period of sodium regimen lasted 3 weeks. No washout period was performed. Blood pressure was recorded for each patient at inclusion and after 3 weeks and 6 weeks. Moreover, all patients were asked to record on a standardized questionnaire everything they ate during 1 week of each period regimen. Questionnaires were analysed by a dietician for mean daily energy and sodium intakes during each period. Mixed models were used to estimate the relationship between sodium intake and blood pressure variations.

RESULTS

Between June 2006 and June 2008, 49 patients were randomized, 24 in group 1 (first period regimen=salt<3g/day; women: 63%; mean age: 56+/-21 years; baseline prednisone dosage: 54+/-19 mg/day) and 25 in group 2 (first period regimen=salt>6g/day; women: 56%; mean age: 60+/-19 years; baseline prednisone dosage: 56+/-16 mg/day). Mean daily salt intakes were 2.5+/-1.8 and 9.3+/-1.9 g/day during the first period and 7.8+/-3.2 and 3.8+/-2.9 g/day during the second period, respectively for group 1 and group 2. Blood pressure variations were not significantly associated with daily salt intakes or with randomisation group. No order effect was evidenced. By comparison with baseline, systolic blood pressure increased by greater than 20 mm Hg at week 6 in five patients (2 in group 1 and 3 in group 2).

CONCLUSION

At short-term, sodium intake does not seem to influence blood pressure variations in patients starting systemic corticosteroids therapy.

Giant cell arteritis in Alaska Natives

OBJECTIVE

To investigate the incidence of biopsy-proven giant cell arteritis in the Native population of Alaska.

DESIGN

Retrospective review of medical diagnostic and Current Procedural Terminology (CPT) codes.

PARTICIPANTS

110,000 Alaska Native patients.

METHODS

We conducted a retrospective review of medical diagnostic codes for temporal arteritis, giant cell arteritis, and anterior ischemic optic neuropathy in the medical records of 110,000 Alaska Native patients seen between 1983 and 2003. We examined this same database in search of the CPT code for the temporal artery biopsy procedure. We also re-examined all temporal artery biopsy specimens that had been reported as positive.

RESULTS

We identified 122 patients whose diagnostic codes matched those of giant cell arteritis, temporal arteritis, or anterior ischemic optic neuropathy. We found that of 20 temporal artery biopsies that had been performed on this group, only 4 were reported to have had positive results. On re-examination of pathologic specimens, 1 of the 4 was found not to meet the latest pathologic criteria for this disease, leaving only 3 cases of biopsy-proven giant cell arteritis. The calculated incidence of giant cell arteritis in the Alaska Native population is approximately 1/100,000 in those over 50 years old.

CONCLUSIONS

Compared with previous epidemiologic studies performed worldwide, our review suggests a very low incidence of biopsy-proven giant cell arteritis among Alaska Natives.

[General practitioners' perception of the impact of corticosteroid-induced adverse events]

BACKGROUND

General practitioners' perception of the discomfort their patients experience because of corticosteroid-induced adverse events is unknown.

METHODS

An observational epidemiological study was conducted in September 2007. Eight hundred and sixty general practitioners belonging to the réseau Sentinelles were asked to complete an electronical questionnaire. The questionnaire aimed to assess their perception of discomfort induced by adverse events induced by a long-term (i.e.,>or=3 months) corticosteroid therapy among their patients. Results were compared with the declaration made by 115 long-term corticosteroid treated patients followed in an internal medicine department.

RESULTS

Two hundred and ninety-three general practitioners responded to the questionnaire (response rate: 34%). They were predominantly male (87%). Forty-eight percent of them reported 400 to 600 monthly visits. The mean length of corticosteroid therapy for patients was 44+/-38 months and the mean daily dosage was 15+/-14 mg. They suffered mainly from lupus erythematosus (33%) or giant cell arteritis (15%). The adverse events considered to be the most disturbing by patients were lipodystrophy (25%), followed by weight gain (18%) and neuropsychiatric complaints (16%). Physicians widely overestimated the discomfort caused by weight gain cited as the most disturbing adverse event by 59% of them and underestimated that induced by mood disorders cited as the most disturbing by only 3% of them.

CONCLUSION

The discomfort caused by corticosteroid-induced neuropsychiatric adverse events are underestimated by general practitioners.

Therapeutic manipulation of glucocorticoid metabolism in cardiovascular disease

The therapeutic potential for manipulation of glucocorticoid metabolism in cardiovascular disease was revolutionized by the recognition that access of glucocorticoids to their receptors is regulated in a tissue-specific manner by the isozymes of 11beta-hydroxysteroid dehydrogenase. Selective inhibitors of 11beta-hydroxysteroid dehydrogenase type 1 have been shown recently to ameliorate cardiovascular risk factors and inhibit the development of atherosclerosis. This article addresses the possibility that inhibition of 11beta-hydroxsteroid dehydrogenase type 1 activity in cells of the cardiovascular system contributes to this beneficial action. The link between glucocorticoids and cardiovascular disease is complex as glucocorticoid excess is linked with increased cardiovascular events but glucocorticoid administration can reduce atherogenesis and restenosis in animal models. There is considerable evidence that glucocorticoids can interact directly with cells of the cardiovascular system to alter their function and structure and the inflammatory response to injury. These actions may be regulated by glucocorticoid and/or mineralocorticoid receptors but are also dependent on the 11beta-hydroxysteroid dehydrogenases which may be expressed in cardiac, vascular (endothelial, smooth muscle) and inflammatory (macrophages, neutrophils) cells. The activity of 11beta-hydroxysteroid dehydrogenases in these cells is dependent upon differentiation state, the action of pro-inflammaotory cytokines and the influence of endogenous inhibitors (oxysterols, bile acids). Further investigations are required to clarify the link between glucocorticoid excess and cardiovascular events and to determine the mechanism through which glucocorticoid treatment inhibits atherosclerosis/restenosis. This will provide greater insights into the potential benefit of selective 11beta-hydroxysteroid dehydrogenase inhibitors in treatment of cardiovascular disease.

[What's new in clinical dermatology?]

For this What's new in clinical dermatology?, I have selected some important publications mainly in the field of the infectious dermatosis and drugs allergy. The Chikungunya virus which is responsible of several epidemics since 2005 seems to be a virus with a cutaneous tropism. Sexually transmitted diseases are still a public health problem and we shall review the situation for syphilis, lymphogranuloma venereum and the new dynamic profile of HIV in France. Lyme disease has been the subject of consensus conference in France and in the United States. Original clinical presentations in relation with infectious agent will be also presented. We shall give a large place to what I call the toxidermatology. During the year 2007, the role of gadolinium in the nephrogenic systemic fibrosis has been confirmed, many publications have reported the side effects of biotherapies on the skin and we shall emphasize the paradoxical of some of them. Hypersensitivity syndrome and notably the controversial role of viral reactivations has been reported. The relationship between psoriasis and metabolic syndrome or cardiovascular risks has been discussed since 2006. New clinical features have been described and will be presented during this session.

[What's new in dermatological therapy?]

A review of the medical literature and of the regulatory agencies website was performed to identify new information about dermatological therapy from October 2006 to October 2007. Care was taken to prioritize results from randomized controlled trials and epidemiological studies of acceptable methodology. In the last year, significant advances have been made in the field of psoriasis, pemphigus, prevention of infection with oncogenic papillomaviruses, leg ulcers, evaluation of lasers and photodynamic therapy. The availability of biological agents for the treatment of psoriasis, auto-immune disease and skin cancer will certainly induce major changes in our therapeutic strategies in the near future. The dermatologist needs to keep-up with new therapies in order to address the therapeutic needs of patients with skin diseases.

[Internal medicine physicians' perception of frequency and impact of corticosteroid-induced adverse events]

INTRODUCTION

Whereas internal medicine physicians frequently prescribe systemic corticosteroids, it is unknown if they assess adequately the frequency and the discomfort caused by corticosteroid-induced adverse events.

METHODS

Using an e-mail questionnaire sent to the 813 internal medicine physicians, members of the French National Society of Internal Medicine, we assessed their perception of the frequency and the discomfort induced by the adverse events of long-term (that is, over or at three months) corticosteroid therapy. At the same time, 121 corticosteroid-treated patients, consulting in a department of internal medicine completed an anonymous questionnaire about the frequency and the discomfort caused by the adverse events of their therapy.

RESULTS

Three hundred and thirty-six out of 813 internal medicine physicians answered to the questionnaire (response rate: 41%) and 115 of the 121 questionnaires distributed to patients were exploitable. The physicians were predominantly male (71%) working mainly in tertiary centers (53%). The mean length of corticosteroids therapy for patients was 44+/-38 months and the mean daily dosage was 15+/-14mg. Lipodystrophy, trophic skin disorders, neuropsychiatric disorders and insomnia were frequent and reported by more than half of patients. The frequency of neuropsychiatric and skin disorders and of lipodystrophy estimated by practitioners was markedly lower than the frequency reported by patients. If morphological changes (weight-gain and lipodystrophy) were cited by practitioners as the most discomforting adverse event, in agreement with patients' opinion, physicians underestimated the discomfort caused by neuropsychiatric disorders and insomnia.

CONCLUSION

Frequency and discomfort caused by corticosteroid-induced neuropsychiatric disorders are underestimated by internal medicine physicians.

Digital photography as an operational tool for assessing corticosteroid-induced lipodystrophy

BACKGROUND

Corticosteroid-induced lipodystrophy (CIL) is exclusively diagnosed in a subjective manner.

OBJECTIVE

To evaluate the reliability of digital photographs in the diagnosis of CIL.

METHODS

All consecutive patients starting long-term, high dosage corticosteroid therapy were photographed at baseline and after 3 months of therapy. At the end of the study, 3 physicians with expertise in corticosteroids classified patients as lipodystrophic yes/no/unclassifiable. Photographs analyses performed by 9 medical readers and evaluation of CIL using visual analog scale (VAS) performed during the M3 visit were compared to this classification.

RESULTS

Eighty-eight patients were monitored. Fifty of them were classified by the 3 experts as lipodystrophic and 30 as not lipodystrophic (8 were unclassifiable). Their intra- and inter-observer agreements were moderate or fair (kappa coefficient<or=0.57) when month 3 photographs were analysed alone and substantial or near perfect (kappa coefficient>or=0.75) when M3 photographs were analysed beside baseline ones. By comparison with expert consensus, only 3 out of 4 patients were correctly classified using VAS. The AUROC curve and inter-observer agreement significantly improved with experience for the 9 non-experts.

CONCLUSION

The use of digital photographs do better than VAS to evaluate CIL. The accuracy of diagnosis improves with experience. Morphological changes are more important than morphological phenotype.

A critical role for vascular smooth muscle in acute glucocorticoid-induced hypertension

Although glucocorticoid (GC)-induced hypertension has commonly been attributed to promiscuous activation of the mineralocorticoid receptor by cortisol, thereby promoting excess reabsorption of sodium and water, numerous lines of evidence indicate that this is not the only or perhaps even the primary mechanism. GC induce a number of effects on vascular smooth muscle (VSM) in vitro that may be pertinent to hypertension, but their contribution in vivo is unknown. To address this question, a mouse model with a tissue-specific knockout (KO) of the GC receptor in the VSM was created and characterized. Similar to control mice, KO mice exhibited normal baseline BP and, interestingly, showed normal circadian variation in BP. When dexamethasone was administered, however, the acute hypertensive response was markedly attenuated in KO mice, and there was a trend toward a decreased chronic hypertensive response. These data suggest that the GC receptor in VSM plays a critical role in the acute hypertensive response to GC in vivo.

Pemphigus: a treatment update

Pemphigus is an uncommon but potentially life-threatening chronic autoimmune bullous disorder. Antibodies are directed against antigens (desmoglein 1 and 3) in the desmosomes linking keratinocytes and against acetylcholine receptors. Conventional treatment with high-dose corticosteroids, sometimes with adjuvant immunosuppressive agents, may be associated with very serious adverse effects. There is an urgent need to establish the evidence for the safest and most effective form of treatment. A literature review has revealed 11 controlled (9 randomized) trials of treatment for pemphigus. The numbers of participants in the individual trials are small and the data cannot be pooled as they evaluate different forms of treatment. The results of these trials suggest that very high doses of corticosteroids, either as pulse therapy or in daily dosage, are not superior to moderate daily doses. Based on evidence from the available trials, addition of an immunosuppressive agent generally does not appear to offer substantial benefit in terms of clinical response. However, a recent study demonstrated a significant reduction in corticosteroid requirements among patients receiving immunosuppressive agents. Newer therapies, such as biologic agents (in particular rituximab), calcineurin inhibitors, or immunoadsorption appear promising but there are inadequate controlled trials to establish their role clearly. Initial open-label studies suggest that specific peptide immunotherapy may offer a safe and novel approach to the treatment of pemphigus in the future. At present, treatment of an individual patient with pemphigus requires clinical judgment and should not be based purely on guidelines or on the inadequate available evidence alone. There is an urgent need for large randomized, controlled, multicenter trials of treatment in patients with pemphigus.

Corticosteroid-induced adverse events in adults: frequency, screening and prevention

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.

[Natural history of corticosteroid-induced lipodystrophy: a prospective follow-up of 37 patients]

PURPOSE

No data is available about the natural history of the corticosteroid-induced lipodystrophy. The purpose of this study is to describe the natural history of corticosteroid-induced lipodystrophy in a selected and homogenous population.

METHODS

We conducted a cohort study between June 2003 and September 2005 and enrolled all consecutive patients starting long-term systemic corticosteroid therapy for giant cell arteritis (because of a standardized therapeutic schedule). After enrollment, patients were seen every month until the end of the corticosteroid therapy. After the drug withdrawal, they consulted every 3 months during 6 months. At each consultation, they were photographed in a standardized way. At the end of the study, the development of lipodystrophy was assessed by analyzing these photographs. We evaluated the incidence of corticosteroid-induced lipodystrophy during the course of giant cell arteritis therapy and the time between initiation of therapy and its apparition. Lastly, we evaluated the time between the prednisone withdrawal and the disappearance of lipodystrophy (or the mean prednisone dosage if the disappearance was observed under treatment).

RESULTS

Thirty-seven patients were included (women: 73%; mean age: 75+/-7 years; mean initial daily prednisone dosage: 44+/-13 mg). The mean duration of follow-up was 23.6+/-7.4 months. Incidence of corticosteroid-induced lipodystrophy was 48% after 3 months and 60% after 12 months of therapy. The median time between treatment initiation and appearance of lipodystrophy was short (3 months [1-4]). During the decrease of the therapy or the 6 months following its end, we observed a regression of lipodystrophy in 71% of the patients. The median time between corticosteroids initiation and disappearance of lipodystrophy was 19 months [16-22] (concomitant median daily dosage of prednisone: 4 mg [0-7]).

CONCLUSION

Lipodystrophy is frequently observed in corticosteroid-treated old patients. It appears precociously after the initiation of therapy and is usually reversible.