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Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1415 (Published 12 April 2017) Cite this as: BMJ 2017;357:j1415

Re: Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study

Thank you for this interesting study

What has been shown is an association rather than causation.: A multivariate regression meta -analysis may help clarify.

The study cannot be appropriately standardized for confounders (there was a reason why the prescribing doctor thought steroids were clearly required at that time in the patient) and thus outcomes are not unexpected in the cohort of users vs non-users. At worst this study could possibly be completely misleading.

Hypothetically: if the group prescribed were instead randomized to half prescribed and half not - then we could tell whether steroids in the short term are harmful or beneficial on the outcomes recorded. It is possible steroids could actually shorten length of illness (and immobility) and actually reduced DVTs etc OR perhaps it is indeed harmful.

The study however is valuable in generating hypotheses and also cautioning in the potential indiscriminate use of steroids. Yet it may cause harm if it influences colleagues to refrain from using steroids in short courses for appropriate reasons.

Competing interests: No competing interests

19 May 2017
AKIF GANI
Consultant Geriatrician
Dept Older Peoples Medicine, NUTH
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