For their discovery of the therapeutic benefits of cortisone, the first corticosteroid drug, the 1950 Nobel Prize in Physiology was awarded to Philip Hench, Edward Kendall and Tadeusz Reichstein. During the more than 70 years since discovery, millions of patients have benefitted from prescription of these potent anti-inflammatory drugs to control autoimmune disorders, inflammation, blood cancers, and transplanted organ rejection. Besides cortisone, the corticosteroids include other common drugs such as prednisone, dexamethasone, fluticasone, difluprednate and mometasone. They are administered systemically (oral, intravenous), locally (inhaled, nasal, intraarticular) and topically (ophthalmic, dermatologic). About 200 million corticosteroid prescriptions are written every year in the U.S. Rx growth is ~5% per year as the population ages, as many indications are more common in the elderly.

 

That corticosteroid-associated side effects limit their utility has been recognized since the 1950s. In many patients, corticosteroids induce metabolic dysfunctions including diabetes, elevated blood pressure, and fat redistribution - 'moon face' is one manifestation but a more dangerous effect is increased liver fat which introduces risk of stroke and heart attack. They decrease bone formation and increase bone cell death, which leads to an increased fracture rate. Corticosteroids can induce glaucoma and cataracts, conditions that cause blindness if untreated. They also affect the brain, and can lead to depression and psychosis in some patients. Among other side effects, one that is pernicious is the withdrawal effects - even after patients have suffered other side effects, they must taper slowly off corticosteroids because the drugs suppress the body's natural stress response system.

 

Corticosteroid side effects cause substantial misery, and cost more to treat than the drugs themselves. Patients and physicians seek to "steroid-sparing" solutions. Therapeutic guidelines for numerous diseases advise doctors to avoid, or minimize dose of, corticosteroids. For a number of diseases (e.g., rheumatoid arthritis, psoriasis) the alternative therapies are targeted immune modulators, the most costly drug class for insurers. 

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