Background/Purpose:

Glucocorticoids (GCs) remain widely used and have well documented adverse effects. However, the impact of these adverse effects from the perspective of the patient, rather than of the clinician, remains relatively unexplored. Additionally, no general patient reported outcome measure has been developed to assess GC adverse effects and impact across rheumatological conditions. The aim of this literature review was to identify the impacts of systemic GC use that are of importance to patients.

Methods:

An academic librarian searched OVID EMBASE, OVID MEDLINE, PsycINFO and CINAHL for articles published from inception to October 2017, related to three concepts: GCs, the patient perspective and adverse effects. Inclusion criteria included systemic GC use for any indication in an adult population and both qualitative and quantitative research methodology. Titles and abstracts were then manually screened by two independent reviewers and subsequent quality assessment and data extraction also completed by two independent reviewers. A meta-synthesis of the qualitative data was performed separately by two independent researchers before qualitative meta-summary was utilized to quantitatively aggregate the findings (combining quantitative and qualitative results), including the derivation of frequency effect sizes to identify those outcomes most prominently featured across all reviewed articles.

Results:

The initial search retrieved 1,356 articles, of which 24 (18 quantitative, 6 qualitative) were deemed suitable for quality assessment and data extraction (Figure). Studies included the assessment of GC use across a variety of diseases both rheumatologic (e.g. RA, vasculitis) and non-rheumatologic (including asthma, inflammatory bowel disease and multiple sclerosis). Four major themes emerged amongst the 71 discrete outcomes (Table): physical symptoms (44), psychological symptoms (18), effect on participation (6) and contextual factors (3).

Conclusion:

Patients with a broad range of inflammatory diseases and demographic features describe key cross-cutting themes in relation to GCs and their impact on health-related quality of life. This work will inform the development of a core domain set for clinical trials involving GCs and a patient reported outcome to measure the impact of GCs from the patient’s perspective.