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So much amazing cross-specialty work being done in the area of #steroidstewardship. To highlight just a few: 1/ https://twitter.com/umichmedicine/status/1344376137078763529
Evan Dvorin, @MRothbergMD Mark Rood & @ktmartinez: 1 in 10 #telemedicine encounters for URI result in #steroid prescribing. HUGE variation across providers, with 10% of docs prescribing 75% of steroids: https://www.amjmed.com/article/S0002-9343(20)30161-3/fulltext 2/
Alastair Hay & many others in Bristol: oral #steroids do not improve LRI symptom duration/severity in adults without asthma or COPD: https://jamanetwork-com.proxy.lib.umich.edu/journals/jama/fullarticle/2649201 3/
Mike George and Josh Baker at @PennRheum and @RADoctor: <=5mg/day prednisone increases annual risk of infection by the same magnitude as biologic medications: https://www.acpjournals.org/doi/abs/10.7326/M20-1594?journalCode=aim 4/
Drs Burmester & Buttgereit in Berlin, and their many collaborators: two-thirds of #RA patients can taper low dose #prednisone (5mg/day) with no RA flare or clinical adrenal insufficiency: https://www.thelancet.com/article/S0140-6736(20)30636-X/fulltext#%20 5/
@EdwardMcCoulMD: an excellent viewpoint commenting on how short-term benefits (financial, patient satisfaction) conflict with long-term harms of #steroid shots for URI: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2771318 6/
@MilenaGianfran, @maio_danila, @patti_katz, @GSchmajukMD, @KWyshamMD, @Drbeckyg, @hausmannMD, @rheum_cat, @emilysirotich, @psufka, @zach_wallace_md, @JYazdanyMD, @philipcrobinson @rheum_covid: baseline use of >=10mg #prednisone increases odds of hospitalization for #COVID19 7/
Yao and collaborators in Taiwan: brief #steroid bursts (median 3 days) significantly increase risk of sepsis, heart failure, and GI bleeding in otherwise young, healthy patients: https://www.acpjournals.org/doi/10.7326/M20-0432?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed 8/
Of course @AkbarWaljee @bnallamo and @UM_IHPI collaborators: #steroid bursts used by 1 in 5 patients in a commercially insured US cohort, with increased rates of sepsis, VTE and fracture during the 30 days after use: https://www.bmj.com/content/357/bmj.j1415 9/
A recent study by Evan Dvorin and @OchsnerHealth reinforces that providers often rx #steroids for conditions where they provide limited/no benefit, a finding echoed by many of the studies linked above https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003058 10/
When you think about prescribing steroids, consider #steroidstewardship principles:
- Are steroids indicated?
- Are there equally effective alternatives?
- Does patient understand risks/benefits?
- What is lowest effective dose/shortest effective duration?
- Are steroids indicated?
- Are there equally effective alternatives?
- Does patient understand risks/benefits?
- What is lowest effective dose/shortest effective duration?
