Information on steroids used as part of ATG treatment

‘Steroid’ is a term that describes a class of chemical compound that is naturally synthesised in the body but can also be manufactured (synthetic steroids) and performs important functions in the body, including suppressing inflammation. Steroids are not a treatment for aplastic anaemia, but they are given with some treatments to reduce the risk of reactions and complications.

Which steroids are used?

Corticosteroids:

There are various types of corticosteroids, which can be taken as tablets or administered as injections, and perform the common function to reduce swelling and inflammation amongst its many functions.

• Prednisolone, which you take as tablets or have as injections
• Methylprednisolone, which you take as injections
• Hydrocortisone, which you have as an injection, often into your veins directly. Hydrocortisone is commonly used along with an antihistamine called piriton to treat or help prevent reactions to blood or platelet transfusions.  You can also be given extra doses
  of hydrocortisone if you are still having reactions to ATG despite being given prednisolone

Anabolic steroids:

These are synthetic or manufactured chemical hormones that help to build up your body tissue. These include danazol and oxymetholone, which you take as a tablet. Please review the anabolic steroid information sheet.

Steroids with ATG

Corticosteroids are given to ensure that ATG treatment for aplastic anaemia does not cause too many side effects. It helps to administer ATG treatment safely. It will help:

Reduce any immediate reactions you may have to ATG, including:

• Fevers
• Shakes
• Rashes

Prevent a delayed (late) reaction to ATG called serum sickness. Serum sickness can happen a few days to weeks after you
have received treatment with ATG. Serum sickness causes various symptoms including:

• Joint stiffness and pains, similar to arthritis
• Muscle aches
• Skin rashes
• Flu-like symptoms
• Fevers

Because it is not possible to predict which patient may get serum sickness, you will be given a course of corticosteroids to try to prevent it. Some patients still get some serum sickness despite taking prednisolone. If this happens, you will be prescribed extra steroids in the form of hydrocortisone injections or other form of steroids for a few days until the serum sickness settles down.

What dose do I take?

The dose depends on how much you weigh, so varies from person to person. You take it as an injection for the first five days, usually before you are administered ATG in the hospital. You are often then switched to oral corticosteroid tablets, which are gradually tapered (dose reduced) and stopped in two weeks.

What are the possible side effects?

Corticosteroids have a number of possible side effects but are generally tolerated well, especially when the course of steroids is only
for a short duration. You are unlikely to develop long-term problems as in most cases of aplastic anaemia, you will be taking it for only a short time with your ATG treatment.

Common side effects that you may get soon after starting prednisolone include:

• Indigestion
• Stomach pains
• An increase in appetite which makes you put on weight
• Your face may swell up slightly and look rounder
• Mood swings, such as feeling depressed or very happy or anxious
• Muscle weakness
• An altered sleep pattern, which you can improve if you take prednisolone earlier in the day (preferably morning)
• A rise in your blood sugar – if you are diabetic you may have to change your diabetic treatment. Your doctor will talk to you about this
• Raised blood pressure

Rare side effects include:

• Increased risk of infection caused by bacteria (bugs) and fungal infections such as candida (thrush) while you are taking steroids
• If you take steroids for a long time they may thin your skin and cause bruising and cataracts. Long-term treatment with prednisolone can cause osteoporosis (thinning of your bones), which makes you more likely to suffer a fracture. However, because you will only take it for a couple of weeks with the ATG treatment, your risk of developing osteoporosis should not increase
• Another rare but serious side effect of prednisolone that can affect your bones is avascular necrosis. This can affect your hip bones and sometimes your shoulders and other joints. Only a small number of people get this condition but again it cannot be predicted who this will be. You are more likely to get it when you take prednisolone for a long time and/or in high doses. You can still – very rarely – develop it when you take prednisolone in a smaller dose and for a short period of time. People who have never been given any prednisolone can also get the condition where patients are more likely than normal to develop osteoporosis and avascular necrosis

Are there any alternative treatments?

There aren’t any alternatives to take. If prednisolone or hydrocortisone is not given, you will be at great risk of severe reactions to ATG.

Do I need any special checks while on steroids?

While you are in hospital having prednisolone as part of your ATG treatment, your doctors and nurses will regularly:

• Check your blood pressure
• Test your urine
• Test your blood for sugar
• Monitor your weight (once to twice a day)
• Check your general condition (every day)

By the time you leave hospital, your dose of prednisolone will already have been reduced.

Can I take other medicines with steroids?

Some medicines interact with prednisolone but many can be taken safely. While you are having prednisolone in hospital, the team looking after you will carefully review all your medicines every day. It is also important to let your doctors know if you are taking any over-the-counter/non-prescription or herbal medicines.

Important note about Chicken-pox

If you have not had chicken-pox but come into contact with someone who has it or shingles, tell your doctor immediately. This is because you may need special treatment. If you develop chicken-pox or shingles you must also tell your doctor straightaway.