Original articleLong-term systemic glucocorticoid therapy: Patients’ representations, prescribers’ perceptions, and treatment adherence
Introduction
Glucocorticoids take pride of place in the treatment of many diseases. The estimated prevalence of systemic glucocorticoid therapy prescribed for 3 months or more is 0.2% to 0.5% in the general population [1], [2] and 1.7% in women older than 55 years of age [2]. Although the benefits of glucocorticoid therapy are well established, they come at the cost of frequent adverse effects (AEs) [3], [4]. Both the occurrence of AEs and patient concerns about possible AEs can result in poor treatment adherence. Perceptions of AEs, particularly regarding their severity and consequences, may differ between patients and physicians.
We conducted surveys among patients and specialist physicians to identify the AEs they deemed most important. Our goal was to improve patient information and, ultimately, treatment adherence based on an analysis of the survey results.
Section snippets
Study design
We conducted two cross-sectional surveys between December 2011 and May 2012. One survey included 125 consecutive outpatients or inpatients at the rheumatology department of the teaching hospital in Casablanca, Morocco. Inclusion criteria were age older than 18 years and oral glucocorticoid therapy for at least 1 month in a daily dosage of at least 5 mg. Patients were given bolus intravenous injections or intra-articular injections of glucocorticoids before the current oral glucocorticoid regimen
Results
The 85 physicians consisted of 16 (18.8%) rheumatologists, 15 dermatologists, 12 nephrologists, 10 gastroenterologists, eight interns, eight neurologists, six pulmonologists, five infectiologists, three oncologists, and two pediatricians. Table 1 reports details on the glucocorticoid treatments prescribed by these physicians. Table 2 shows the main characteristics of the 125 study patients. Among them, 66 (53%) patients adhered to the adjuvant treatments, including 52 who adhered to vitamin D
Discussion
We found high rates of glucocorticoid AEs reported by both patients and physicians. The patients underestimated the occurrence of AEs, whereas the physicians underestimated the neuropsychiatric symptoms. Our results are consistent with earlier data on the AEs of long-term glucocorticoid therapy. In addition, our finding that physicians underestimated the occurrence of neuropsychiatric symptoms is in agreement with two earlier studies [5], [6]. Endogenous and exogenous glucocorticoids exert
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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