Long-term adverse events of oral corticosteroids used for chronic rhinosinusitis

Chronic rhinosinusitis is a chronic inflammatory disease of the nasal cavity and paranasal sinuses that leads to nasal obstruction, hyposmia and significant deterioration in quality of life. It occurs in about 5%-to-12% of people worldwide, with approximately one-third also presenting with nasal polyps. Chronic rhinosinusitis with nasal polyps has a high recurrence rate, often requiring repeated medical or surgical interventions, and resulting in substantial socioeconomic and healthcare burdens.Oral corticosteroids are often used in the management of chronic rhinosinusitis with nasal polyps to control inflammation. Despite guidelines recommending restriction of systemic corticosteroids to short-term courses for exacerbation control, many patients continue to receive systemic corticosteroids on a recurrent or prolonged basis. Evidence on the long-term safety of repeated or high-dose oral corticosteroid exposure in this population is limited. To explore this issue, researchers investigated the association between the intensity, cumulative dose and frequency of oral corticosteroid exposure and systemic adverse events in patients with chronic rhinosinusitis with nasal polyps.The retrospective, nested case-control study was funded by the Korean government. It included adults (≥ 20 years) who received their first diagnosis of chronic rhinosinusitis with nasal polyps, but excluded those diagnosed with an immune-mediated inflammatory disease (e.g., rheumatoid arthritis, systemic lupus erythematosus) within the previous two years or those diagnosed with one of the adverse event outcomes of interest in the previous two years (e.g., avascular bone necrosis, cataract, dyslipidemia, fracture, glaucoma, heart failure, hypertension, myocardial infarction, osteoporosis, pneumonia, stroke, type 2 diabetes). Data were obtained from the Korean Health Insurance Review and Assessment Service database (2010–2023), which covers approximately 98% of the South Korean population. Patients who developed adverse events from oral corticosteroids (case patients) were matched 1:10 with controls by age, sex and diagnosis date.Oral corticosteroid exposure was quantified using three metrics: exposure intensity (annual duration: low [≤ 30 days], moderate [31–90 days] or high [> 90 days]); cumulative dose (< 0.5 g, 0.5–1.0 g, or ≥ 1.0 g prednisolone-equivalents per year); and prescription frequency.The main outcome was the first occurrence of systemic adverse events following oral corticosteroid exposure. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable conditional logistic regression.Key results:The study identified 165,361 patients with chronic rhinosinusitis with nasal polyps who were prescribed at least one oral corticosteroid. The matched cohort included 523,316 patients (51,647 case patients and 472,369 controls; mean age, 47.1 years; 39.7% women). High exposure intensity (> 90 days per year) was associated with a significantly increased risk of avascular bone necrosis, osteoporosis and pneumonia. A cumulative dose > 1.0 g per year was associated with a 23% higher overall adverse event risk (adjusted OR, 1.23; 95% CI, 1.11–1.36) and increased risks of avascular bone necrosis, pneumonia, dyslipidemia, heart failure, hypertension and type 2 diabetes. Prescription frequency was not independently associated with adverse event risk. Spacing oral corticosteroid prescriptions apart did not mitigate harm, highlighting that cumulative dose, rather than episodic frequency, is the key determinant of risk. The authors conclude that in this nested case-control study of patients with chronic rhinosinusitis with nasal polyps, higher oral corticosteroid exposure, in terms of annual days of use and cumulative dose, was associated with an increased risk of systemic adverse events, particularly avascular bone necrosis, osteoporosis and pneumonia. These findings support limiting annual oral corticosteroid exposure to < 90 days or < 1 g prednisolone-equivalents whenever possible. The results also reinforce the need to develop evidence-based, steroid-sparing treatment approaches in the long-term management of chronic rhinosinusitis with nasal polyps.Reference1. Moon S, Lee M, Jung I, et al. Oral corticosteroids and adverse events in chronic rhinosinusitis with nasal polyps. JAMA Otolaryngol Head Neck Surg 2026. Published Online: June 4, 2026. (accessed June 9, 2026).

Long-term adverse events of oral corticosteroids used for chronic rhinosinusitis

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