Long-term systemic glucocorticoid therapy: patients' representations, prescribers' perceptions, and treatment adherence.

Abstract Introduction Glucocorticoids have been used since 1948 for their anti-inflammatory and structural effects in various inflammatory diseases. The optimal use of glucocorticoids remains controversial. Patients may have a number of concerns about the effects of glucocorticoids. Many factors can adversely affect treatment adherence. Objectives To evaluate the main adverse effects reported by patients and physicians, and to assess representations associated with glucocorticoid therapy and the underlying disease, via measurements of treatment adherence, with the goal of optimizing treatment strategies and improving patient information. Methods From December 2011 to May 2012, we conducted two surveys in 125 patients receiving long-term glucocorticoid therapy and followed-up at the rheumatology department of the teaching hospital in Casablanca, Morocco, and in 85 hospital physicians in various specialties, respectively. Results Mean glucocorticoid therapy duration was 6 years, mean maximal prescribed dosage was 44.87 mg/d, and 50.4% of the patients had inflammatory joint disease. Adverse neuropsychiatric effects were reported by 70 out of 125 (56%) patients. Weight gain was the adverse effect deemed most bothersome by the physicians, who significantly underestimated the occurrence of neuropsychiatric adverse effects (27% vs 56%, P  = 0.034). Adherence was poor in 80 out of 125 (64%) patients, and 22 out of 125 (18%) patients reported episodes of treatment discontinuation. Conclusion Prescribers underestimate the frequency of neuropsychiatric adverse effects of long-term systemic glucocorticoid therapy. Regular follow-up visits during treatment, with collection of systemic adverse effects might improve treatment adherence.