The Corticosteroid Stewardship Alliance has released a new white paper, Advancing Safer, More Accountable Use of Corticosteroids, calling for a coordinated approach to improve patient safety while preserving access to one of medicine’s most widely used treatments. The white paper, based on insights from clinical experts, patient advocates and health policy leaders, examines the growing evidence of harm resulting from cumulative corticosteroid exposure and sets forth opportunities to reduce the risk of injury.
Corticosteroids remain an essential treatment option for many inflammatory, autoimmune, allergic, respiratory and other chronic conditions. For countless patients, they provide rapid symptom relief. However, the white paper notes that patients often receive corticosteroids from multiple clinicians, through different routes of administration and across repeated episodes of care, making cumulative exposure difficult to recognize. Over time, that exposure has been associated with adverse metabolic, cardiovascular, musculoskeletal, dermatologic, neuropsychiatric and ophthalmic events.
Looking Beyond Individual Prescriptions
Rather than limiting access to corticosteroids, the report introduces “corticosteroid stewardship” as a framework for ensuring these medications are used as safely and intentionally as possible. Modeled after successful stewardship efforts in areas such as opioid prescribing, the approach emphasizes understanding a patient’s cumulative corticosteroid exposure, improving coordination across specialties and strengthening monitoring over time.
The report also identifies several barriers that make stewardship difficult today. Electronic health records often do not track cumulative exposure across prescriptions. Standardized measures for assessing corticosteroid burden are lacking and many patients are unaware that different medications contribute to their overall steroid exposure. Health plan utilization management practices may also increase repeated corticosteroid use by delaying access to alternative non-steroid therapies.
Putting Stewardship into Practice
To address these challenges, the white paper recommends a combination of patient and clinician education, improved clinical tools and targeted policy reforms. Priority recommendations include expanding awareness of corticosteroid-related risks, developing electronic health record tools to monitor cumulative exposure, strengthening clinical decision support and incorporating cumulative exposure into policy discussions about reform to step therapy protocols and patient safety.
The release of Advancing Safer, More Accountable Use of Corticosteroids marks an important step toward building a more coordinated approach to corticosteroid prescribing. By bringing together clinicians, patients and policymakers around a shared framework, the Corticosteroid Stewardship Alliance hopes to improve patient safety while ensuring corticosteroids remain available for the patients who need them most.
