[Internal medicine physicians' perception of frequency and impact of corticosteroid-induced adverse events]. / Perception par les médecins internistes de la fréquence et de la gêne induite par les effets indésirables d'une corticothérapie systémique prolongée.

ABSTRACT

INTRODUCTION: Whereas internal medicine physicians frequently prescribe systemic corticosteroids, it is unknown if they assess adequately the frequency and the discomfort caused by corticosteroid-induced adverse events. METHODS: Using an e-mail questionnaire sent to the 813 internal medicine physicians, members of the French National Society of Internal Medicine, we assessed their perception of the frequency and the discomfort induced by the adverse events of long-term (that is, over or at three months) corticosteroid therapy. At the same time, 121 corticosteroid-treated patients, consulting in a department of internal medicine completed an anonymous questionnaire about the frequency and the discomfort caused by the adverse events of their therapy. RESULTS: Three hundred and thirty-six out of 813 internal medicine physicians answered to the questionnaire (response rate 41%) and 115 of the 121 questionnaires distributed to patients were exploitable. The physicians were predominantly male (71%) working mainly in tertiary centers (53%). The mean length of corticosteroids therapy for patients was 44+/-38 months and the mean daily dosage was 15+/-14mg. Lipodystrophy, trophic skin disorders, neuropsychiatric disorders and insomnia were frequent and reported by more than half of patients. The frequency of neuropsychiatric and skin disorders and of lipodystrophy estimated by practitioners was markedly lower than the frequency reported by patients. If morphological changes (weight-gain and lipodystrophy) were cited by practitioners as the most discomforting adverse event, in agreement with patients' opinion, physicians underestimated the discomfort caused by neuropsychiatric disorders and insomnia. CONCLUSION: Frequency and discomfort caused by corticosteroid-induced neuropsychiatric disorders are underestimated by internal medicine physicians.