Prescription Steroids Can Pose Risks for Sickle Cell Sufferers

By Steven Reinberg HealthDay Reporter

Folks with sickle cell disease who take corticosteroids to deal with asthma or irritation might undergo extreme pain and even must be hospitalized, researchers report.

This response to corticosteroids might be significantly extreme amongst older folks, girls and sufferers not taking the drug hydroxyurea to deal with their sickle cell signs. These had been the most definitely to be hospitalized, the examine discovered.

“People with sickle cell ought to attempt to search care with any person who has some expertise with sickle cell or is aware of about tips,” stated Dr. Lewis Hsu, chief medical officer of the Sickle Cell Disease Affiliation of America, who reviewed the findings.

Present sickle cell tips advise towards using oral corticosteroids, stated Hsu, a pediatric hematologist and director of the Sickle Cell Heart on the College of Illinois in Chicago.

However, he added, many docs are unaware of those tips until they usually deal with sickle cell sufferers, which is why sufferers themselves ought to pay attention to the risks of taking oral or IV steroids.

“The rationale for the advice towards steroids is that individuals have described this sample of pain,” Hsu stated. “It truly magically works for a day or two. However then a couple of days later, bam, the individual comes again with pain that is worse and generally a lot worse than they’d earlier than. I’ve had that personally occur with sufferers who bought steroids as a result of that is the usual factor for his or her asthma.”

He added that inhaled steroids to deal with asthma usually are not related to this rebound pain.

Sickle cell anemia is an inherited disease attributable to a change in a gene that indicators the physique to make hemoglobin, a compound in red blood cells. In sickle cell sufferers, red blood cells turn out to be inflexible, sticky and misshapen, in line with the Mayo Clinic. Episodes of maximum ache are a significant symptom of the illness.

For the examine, revealed April 26 within the journal Blood, a workforce led by Dr. Ondine Walter of Toulouse College Hospital in France collected information on greater than 5,100 French sufferers with sickle cell illness.

Researchers pressured that this examine cannot show that corticosteroids trigger ache and hospitalization in sickle cell sufferers, solely that their use is related to these occasions.

They discovered, nonetheless, that sufferers given oral corticosteroids had been extra more likely to be hospitalized for a kind of ache often known as vaso-occlusive episodes (VOE). VOEs, the most typical issues of sickle cell illness, could cause intense ache and irreversible organ harm.

However sufferers taking hydroxyurea for his or her sickle cell illness had been much less more likely to undergo ache linked to corticosteroids, the examine discovered. The chance for hospitalization was additionally decrease in males than in girls, and decrease in youngsters than in adults, researchers stated.

The median time between filling a corticosteroid prescription and hospitalization was 5 days, that means half of sufferers had been hospitalized sooner and half later. In all, 46% of sufferers within the French examine had been prescribed not less than one corticosteroid.

Hsu was shocked by that top share.

“Their use of steroids in sickle cell sufferers was way over I’ve ever seen within the U.S.,” he famous.

Researcher Walter stated the danger of hospitalization was decrease in younger males and in sufferers who had been additionally taking hydroxyurea to cut back ache occasions attributable to sickle cell illness and their want for blood transfusions.

“Nonetheless, primarily based on these outcomes, we nonetheless have to assume twice about utilizing corticosteroids when treating sufferers with sickle cell illness,” Walter stated in a journal information launch.

Walter famous that the examine discovered that corticosteroids are sometimes prescribed for circumstances unrelated to a affected person’s underlying sickle cell illness.

“Vaso-occlusive occasions and associated hospitalization seem to comply with corticosteroid prescription pretty rapidly,” Walter stated. “This proof suggests corticosteroids could also be contributing to the occasions and must be averted as a lot as doable in these sufferers.”

Anemia: Common Causes, Symptoms, Types, and Treatment See Slideshow

Hsu defined that VOE pain episodes normally happen when steroids are stopped abruptly, so when they’re obligatory, he slowly weans sufferers off the meds over a number of days.

“I’d give them three or 5 days after which from that full dose go down and down and down and down with a taper over one other 5 days or seven days,” he stated.

Hsu stated docs ought to keep away from prescribing steroids to sickle cell sufferers.

“For asthma, it might be to make use of extra inhaled steroids, which don’t provide you with this drawback of ache, and different anti-inflammatories for treating autoimmune circumstances that do not contain steroids in any respect,” Hsu stated.

Dr. Banu Aygun, a pediatric hematology oncology specialist at Cohen Kids’s Medical Heart in New Hyde Park, N.Y., agreed.

“This examine confirms what we have now been doing to keep away from utilizing steroids in sickle cell illness,” she stated. “If you must use it for a medical motive, you must watch out and use some warning.”

As a result of some docs is probably not conscious of the risks of utilizing steroids with sickle cell sufferers, Aygun thinks sufferers must be proactive.

“Sufferers must be knowledgeable about this, and if they’ll be placed on steroids they both should let their hematologist know or they should let the therapy workforce know that steroids should not be stopped abruptly, however they must be tapered off,” she stated.

Sickle cell illness impacts an estimated 100,000 Individuals. One in each 365 Black infants and 1 in each 16,300 Hispanic infants are affected, in line with the U.S. Facilities for Illness Management and Prevention.

Extra data

For extra on sickle cell illness, see the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Lewis Hsu, MD, pediatric hematologist, chief medical officer, Sickle Cell Illness Affiliation of America, and director, Sickle Cell Heart, College of Illinois, Chicago; Banu Aygun, pediatric hematology oncology specialist, Cohen Kids’s Medical Heart, New Hyde Park, N.Y.; Blood, examine and information launch, April 26, 2022

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