Patients with sickle cell disease (SCD) who take corticosteroids are at a significantly increased risk of hospitalization for pain crises, also known as vaso-occlusive events (VOEs), according to a new study published in Blood. Age, female sex, and those not taking hydroxyurea were among the most at risk of hospitalization.

“Individuals living with SCD often suffer crippling episodes of pain, which can greatly impair their quality of life,” said Ondine Walter, MD, of Toulouse University Hospital in France.

“Based on our data, corticosteroids are commonly prescribed for conditions unrelated to their underlying SCD. [VOEs] and related hospitalization appear to follow corticosteroid prescription fairly quickly. This evidence suggests corticosteroids may be contributing to the events and should be avoided as much as possible in these patients.”

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The research team assessed data from 5151 patients with SCD between 2010 and 2018. They reported a mere 5-day median time between patients receiving a prescription for corticosteroids and their hospitalization, along with the fact that nearly half of patients with SCD studied had received a prescription for systemic corticosteroids.

Those patients taking hydroxyurea, a drug prescribed to reduce VOEs and the need for blood transfusions, were less likely to be hospitalized, indicating a possible protective effect of this medication on VOEs. Men and children were also less likely to be hospitalized than adult women.

The authors caution that corticosteroid exposure measurements were based on dispensing data, so whether patients actually took the medicine has not been confirmed. However, related studies have shown that withdrawal of corticosteroids in patients with SCD is associated with rebound pain. The American Society of Hematology recommends against corticosteroid use in this population for pain management, and these study results further highlight the importance of avoiding them in SCD whenever possible.

Reference

Corticosteroids raise the risk of hospitalization for pain crises among individuals living with sickle cell disease. News release. EurekAlert; April 26, 2022.