Investigating the risks of long-term glucocorticoid and attenuated androgen use in patients with angioedema: A systematic literature review.
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All Authors
Aygoren-Pursun E.
Bara N.-A.
Buttgereit T.
Cimbollek S.
Cohn D.M.
Farkas H.
Kiani-Alikhan S.
Magerl M.
Mandelin J.M.
Riedl M.A.
LTHT Author
Savic, Sinisa
LTHT Department
NIHR-Leeds Biomedical Research Centre
Pathology
Clinical Immunology & Allergy
Pathology
Clinical Immunology & Allergy
Non Medic
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
ANGIONEUROTIC EDEMA , GLUCOCORTICOIDS , QUALITY OF LIFE , ANDROGENS , DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS
Subject Headings
Abstract
Background: Angioedema (AE) is charac-terized by leakage of fluid into tissues resulting in localized swelling. It is often categorized by two known mechanisms: mast cell (AE-MC) or bradykinin-mediated (AE-BK). Management of AE is focused on symptom control. In AE-MC this is often achieved with antihistamines, monoclonal antibodies, glucocorticoids, but in AE-BK, drugs such as C1-INH, kallikrein inhibitors, and androgens are used. While treatment varies, adverse effects have been observed with long-term use of glucocorticoids and androgens. Here, we aimed to evaluate the risks and side effects of long-term glucocorticoid and androgen use in patients with AE. Method(s): A systematic literature review (SLR) was performed using PubMed, and publications related to long-term glucocorticoid and androgen use were identified using separate search strings. Literature reviews and publications that were written in non-English languages or included non-human data were excluded. Grant funding (#80019) for this SLR was provided to ACARE by BioCryst Pharmaceuticals Inc. Result(s): Overall, 61 publications concerning the long-term use of glucocorticoids (n = 5) and androgens (n = 56) for the management of AE met the search criteria. Across the publications, patients were often prescribed glucocorticoids such as dexamethasone and prednisone, and androgens such as danazol and stanozolol. Long-term glucocorticoid and androgen use allowed some patients to experience improvements in their symptoms and quality-of-life. However, others experienced multisystemic adverse effects including abnormal liver function, indigestion, hirsutism, menstrual irregularities, behavioural changes and mood disorders (e.g., aggression, anxiety, depression), as well as cardiometabolic changes (e.g., elevated cholesterol, hypertension). Dosage adjustments and changes to therapeutic regimens were able to address certain adverse effects (e.g., depression, hirsutism, menstrual irregularities, weight gain). However, other more severe effects were irreversible and, in some cases, life threatening (e.g., hepatocellular carcinoma). Conclusion(s): The findings from this SLR underscore the need to minimize use of glucocorticoids and androgens where possible and encourage the use of effective modern treatments to reduce the risk of long-term adverse effects. Where modern therapies are not yet available, physicians should aim to prescribe the lowest effective dose of glucocorticoids or androgens and closely monitor for side effects.
Journal
Allergy, Asthma and Clinical Immunology