2016 Section 5 Green Book

7. Chrousos GP. Adrenocorticosteroids and adrenocortical antagonists. In Basic and Clinical Pharmacology, 10th ed. Katzung BG (Ed). New York: McGraw-Hill, 635–652, 2007. 8. Segal BH, and Sneller MC. Infectious complications of immunosup- pressive therapy in patients with rheumatic diseases. Rheum Dis Clin North Am 23:219–237, 1997. 9. Conn HO, and Poynard T. Corticosteroids and peptic ulcer: Meta- analysis of adverse events during steroid therapy. J Intern Med 236:619–632, 1994. 10. Stuck AE, Minder CE, and Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 11:954–963, 1989. 11. O’Donnell MR, Schmidt GM, Tegtmeier BR, et. al. Prediction of systemic fungal infection in allogeneic marrow recipients: Impact of amphotericin prophylaxis in high-risk patients. J Clin Oncol 12:827– 834, 1994. 12. Fukuda T, Boeckh M, Carter RA, et al. Risks and outcomes of inva- sive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 102:827– 833, 2003. 13. Lionakis MS, and Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Lancet 362:1828–1838, 2003. 14. Upton A, Kirby KA, Carpenter P, et al. Invasive aspergillosis follow- ing hematopoietic cell transplantation: Outcomes and prognostic fac- tors associated with mortality. Clin Infect Dis 44:531–540, 2007. 15. Marr KA, Carter RA, Boeckh M, et al. Invasive aspergillosis in allo- geneic stem cell transplant recipients: Changes in epidemiology and risk factors. Blood 100:4358–4366, 2002. 16. Atkinson JB, Kosi M, Srikanth MS, et al. Growth hormone reverses impaired wound healing in protein-malnourished rats treated with corticosteroids. J Pediatr Surg 27:1026–1028, 1992. 17. Nguyen H, Lim J, Dresner ML, and Nixon B. Effect of local cortico- steroids on early inflammatory function in surgical wound of rats. J Foot Ankle Surg 37:313–318, 1998. 18. Goforth P, and Gudas CJ. Effects of steroids on wound healing: A review of the literature. J Foot Surg 19:22–28, 1980. 19. Suh DY, Hunt TK, and Spencer EM. Insulin-like growth factor-I reverses the impairment of wound healing induced by corticoste- roids in rats. Endocrinology 131:2399–2403, 1992. 20. Lenco W, McKnight M, and MacDonald AS. Effects of cortisone acetate, methylprednisolone and medroxyprogesterone on wound contracture and epithelialization in rabbits. Ann Surg 181:67–73, 1975. 21. Keenan GF. Management of complications of glucocorticoid therapy. Clin Chest Med 18:507–520, 1997. 22. Allen DB, Bielory L, Derendorf H, et al. Inhaled corticosteroids: Past lessons and future issues. J Allergy Clin Immunol 112(suppl.):S1–S40, 2003. 23. Ton FN, Gunawardene SC, Lee H, and Neer RM. Effects of low dose prednisone on bone metabolism. J Bone Miner Res 20:464–470, 2005. 24. van Staa TP, Leufkens HG, and Cooper C. The epidemiology of corticosteroid-induced osteoporosis: A meta-analysis. Osteoporos Int 13:777–787, 2002. 25. Cui Q, Wang G-J, and Balian G. Steroid-induced adipogenesis in a pluripotential cell line from bone marrow. J Bone Joint Surg Am 79:1054–1063, 1997. 26. Mirzai R, Chang C, Greenspan A, and Gershwin ME. The pathogen- esis of osteonecrosis and the relationship to corticosteroids. J Asthma 36:77–95, 1999. 27. McKee MD, Waddell JP, Kudo PA, et al. Osteonecrosis of the femoral head in men following short-course corticosteroid therapy: A report of 15 cases. CMAJ 164:205–206, 2001. 28. Wong GK, Poon WS, and Chiu KH. Steroid-induced avascular ne- crosis of the hip in neurosurgical patients: Epidemiological study. ANZ J Surg 75:409–410, 2005. 29. Carnahan MC, and Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 11: 478–483, 2000. 30. Piper JM, Ray WA, Daugherty JR, et al. Corticosteroid use and peptic ulcer disease: Role of nonsteroidal anti-inflammatory drugs. Ann Intern Med 114:735–740, 1991. 31. Asare K. Diagnosis and treatment of adrenal insufficiency in the critically ill patient. Pharmacotherapy 27:1512–1528, 2007.

steroid use. Thirty-four of the cases were either decided for the plaintiff or settled with an average indemnity payment of $1.15 million. A more complete discussion of litigation associated with steroid use can be found in the review by Poetker and Smith. 44 USE OF STEROIDS IN CRS Recently, an iterative review was performed that evaluated the data that support the use of steroids in patients with CRS. 45 The research- ers initially evaluated the data that supported steroids in patients with CRS and without nasal polyps by identifying four level-4 stud- ies. Despite the common use of oral steroids for CRS without nasal polyps, there is no study that evaluated its efficacy as a single agent for CRS. In fact, there are no high-level studies that support steroid use even as a component of a multidrug regimen. High-quality stud- ies are needed to validate efficacy and proper dosing. Given the potential risks of oral steroids, the expert panel thought that the use of oral steroid in CRS without polyposis is optional. They indicated that patients with more severe disease may have a more favorable benefit-to-harm ratio than patients with mild disease. When evaluating the use of oral steroids in patients with CRS and with nasal polyps, 16 articles were identified, 50–65 5 of which had level-2 evidence. 61–65 All the studies showed positive changes in the majority of the parameters evaluated. Analysis of the data supports the use of oral steroids in patients with CRS and with nasal polyps in the immediate and short-term period. All the studies showed benefit with very few adverse effects, and no severe adverse events were reported. The researchers made a strong recommendation for the use of oral steroids in the management of patients with CRS and with nasal polyps, provided the use was short term. They further recom- mended the perioperative use of oral steroids in these patients, based on two level-2 studies 66,67 and one level-3 study, 68 which showed improved visualization during surgery and improved postoperative courses. Multiple treatment options exist for CRS, with each option carrying varying degrees of success in the management of the disease. 69 One must keep in mind that all treatment options carry risks. These include the risks of surgery as well as the risks of antibiotics. 70,71 The relative risks must be considered, weighed, and discussed. Ulti- mately, it is the patient who must accept these risks, and it is the provider’s responsibility to educate the patient by ensuring that an informed decision is made. CONCLUSION In this review, I attempted to provide an overview of the existing data of the risks of oral steroid use, the lawsuits associated with their use, and the data that support the use of steroids in the CRS patient population. No medication or intervention is without risk. Providers need to be aware of the potential complications and the data that support the use to provide the best care possible. REFERENCES 1. Dubin MG, Liu C, Lin SY, and Senior BA. American Rhinologic Society member survey on “maximal medical therapy” for chronic rhinosinusitis. Am J Rhinol 21:483–488, 2007. 2. Cope D, and Bova R. Steroids in otolaryngology. Laryngoscope 118: 1556–1560, 2008. 3. Poetker DM, and Reh, DD. A comprehensive review of the adverse effects of corticosteroids. Otolaryngol Clin North Am 43:753–768, 2010. 4. Fardet L, Kassar A, Cabane J, and Flahault A. Corticosteroid-induced adverse events in adults. Drug Safety 30:861–881, 2007. 5. Fardet L, Cabane J, Lebbe´ C, et al. Incidence and risk factors for corticosteroid-induced lipodystrophy: A prospective study. J Am Acad Dermatol 57:604–609, 2007. 6. Hirsch IB, and Paauw DS. Diabetes management in special situations. Endocrinol Metab Clin North Am 26:631–645, 1997.

American Journal of Rhinology & Allergy

141