LEXINGTON, MASS--Intranasal corticosteroid use does not increase the risk of cataracts, according to a large retrospective study.[1] In contrast, oral corticosteroid use was associated with a dose-dependent increase in the risk of cataracts.

Previous studies have documented a link between long-term oral corticosteroid use and ocular side effects. However, the systemic effects of intranasal corticosteroids are less clear. Specifically, the risk of cataracts among intranasal corticosteroid users who are younger than age 65 years was unknown.

To determine the incidence of cataracts among users of intranasal corticosteroids, researchers examined medical records from 286,078 subjects younger than age 70 years. Of this cohort, 88,301 people had used only intranasal corticosteroids (beclomethasone, fluticasone, budesonide), 98,901 had used only oral corticosteroids (prednisolone, prednisone, methylprednisolone, dexamethasone, betamethasone), and 98,876 had never used either form of the drugs.

ORAL STEROIDS DOUBLE RISK

A total of 1,059 patients with first-time cataracts were identified, of whom 217 were in the intranasal corticosteroid group, 629 were in the oral corticosteroid group, and 213 were in the unexposed group. The incidence of cataracts per 1,000 person-years of use was similar among the intranasal and unexposed groups (1.0) but was significantly increased in the oral group (2.2).

The cataract risk was not affected by the number of intranasal corticosteroid prescriptions filled. However, the relative risk associated with oral corticosteroid use increased from 1.2 with two to four prescriptions to 2.1 with five to nine prescriptions and to 4.6 with 10 or more prescriptions.

CONFLICTING RESULTS

Lead author Laura E. Derby, DSc, Senior Epidemiologist at the Boston Collaborative Drug Surveillance Program, acknowledged that two previous observational studies had suggested a link between inhaled corticosteroids and cataracts, but she believes that the investigations had several limitations.[2,3] "One of the studies had a small sample size and used subject recall of drug use, which is always chancy. It wasn't even clear that use of the drug was prior to the development of the cataract. Therefore, the results of this study should be seen as interesting information for hypothesis formation only," she told PULMONARY REVIEWS.

"The second study was in subjects in a different age group (ie, older than 70 years)," she added. "Furthermore, these were studies of inhaled, not intranasal, corticosteroid use, and the inhaled agents have different dosages and possibly systemic absorption."

While further studies are necessary, Dr. Derby believes that the new findings "may provide some reassurance regarding use of intranasal steroids in subjects less than 70 years of age in terms of risk of cataracts."

--Kristin Della Volpe

References
1. Derby L, Maier WC. Risk of cataract among users of intranasal corticosteroids. J Allergy Clin Immunol. 2000;105:912-916.
2. Cumming RG, Mitchell P, Leeder SR. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med. 1997;337:8-14.
3. Garbe E, Suissa S, LeLorier J. Association of inhaled corticosteroid use with cataract extraction in elderly patients. JAMA. 1998;280:539-543.

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