PMID- 31812351
OWN - NLM
STAT- MEDLINE
DCOM- 20210427
LR  - 20210427
IS  - 1532-866X (Electronic)
IS  - 0049-0172 (Linking)
VI  - 50
IP  - 3
DP  - 2020 Jun
TI  - The safety of pulse corticosteroid therapy- Systematic review and meta-analysis.
PG  - 534-545
LID - S0049-0172(19)30687-0 [pii]
LID - 10.1016/j.semarthrit.2019.11.006 [doi]
AB  - OBJECTIVE: To amass all available evidence from randomized controlled trials 
      regarding the safety of pulse corticosteroids therapy, in order to establish its 
      safety. PATIENTS AND METHODS: All electronic databases from 1/1966 up to 02/2019 
      were reviewed to find all randomized controlled trials comparing pulse 
      corticosteroids to oral corticosteroids or to placebo/no treatment. Two reviewers 
      independently extracted and recorded data regarding type of corticosteroid 
      treatment, dosages, length of treatment and follow-up. Risk ratios (RR) with 95% 
      (CI) for differences between pulse corticosteroids and comparator were pooled 
      using a fixed effect meta-analysis. The primary outcome was occurrence of severe 
      adverse events (SAEs). Secondary outcomes included any adverse events (AEs), AEs 
      requiring discontinuation, AEs per system involved and all-cause mortality. 
      RESULTS: A total of 64 trials were included: 18 trials which compared pulse 
      corticosteroids to oral corticosteroids and 46 trials which compared pulse 
      corticosteroids to placebo/no intervention. Pulse corticosteroids was not 
      associated with increased risk for SAEs for both comparators: RR 0.77 (95% CI 
      0.52-1.14), and RR 0.99 (95% CI 0.93-1.06), respectively. Sensitivity analysis 
      based on adequate allocation concealment and use of a valid AE grading did not 
      alter the results. Subgroup analysis revealed no increased risk of specific SAEs 
      or AEs with pulse corticosteroids compared to oral corticosteroids. CONCLUSION: 
      Pulse corticosteroids was not associated with an increase risk of SAEs and should 
      be regarded as safe.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Edel, Yonatan
AU  - Edel Y
AD  - Rheumatology unit Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; 
      Department of Medicine C, Beilinson Hospital, Rabin Medical Center, Petah Tikva 
      49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel. 
      Electronic address: yonatanad@clalit.org.il.
FAU - Avni, Tomer
AU  - Avni T
AD  - Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 
      Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
FAU - Shepshelovich, Daniel
AU  - Shepshelovich D
AD  - Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 
      Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
FAU - Reich, Shelley
AU  - Reich S
AD  - Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 
      Israel.
FAU - Rozen-Zvi, Benaya
AU  - Rozen-Zvi B
AD  - Nephrology unit Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; 
      Sackler Faculty of Medicine, Tel Aviv University, Israel.
FAU - Elbaz, Michal
AU  - Elbaz M
AD  - Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 
      Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
FAU - Leibovici, Leonard
AU  - Leibovici L
AD  - Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 
      Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
FAU - Molad, Yair
AU  - Molad Y
AD  - Rheumatology unit Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; 
      Sackler Faculty of Medicine, Tel Aviv University, Israel.
FAU - Gafter-Gvili, Anat
AU  - Gafter-Gvili A
AD  - Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 
      Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20191114
PL  - United States
TA  - Semin Arthritis Rheum
JT  - Seminars in arthritis and rheumatism
JID - 1306053
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - Adrenal Cortex Hormones/*administration & dosage/adverse effects
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Humans
MH  - Middle Aged
MH  - Pulse Therapy, Drug
MH  - Randomized Controlled Trials as Topic
COIS- Declaration of Competing Interest None.
EDAT- 2019/12/10 06:00
MHDA- 2021/04/28 06:00
CRDT- 2019/12/09 06:00
PHST- 2019/06/24 00:00 [received]
PHST- 2019/09/05 00:00 [revised]
PHST- 2019/11/08 00:00 [accepted]
PHST- 2019/12/10 06:00 [pubmed]
PHST- 2021/04/28 06:00 [medline]
PHST- 2019/12/09 06:00 [entrez]
AID - S0049-0172(19)30687-0 [pii]
AID - 10.1016/j.semarthrit.2019.11.006 [doi]
PST - ppublish
SO  - Semin Arthritis Rheum. 2020 Jun;50(3):534-545. doi: 
      10.1016/j.semarthrit.2019.11.006. Epub 2019 Nov 14.