A.2 Corticosteroid management in neuromuscular disease: a Canadian Survey

Abstract

Background: Systemic corticosteroids (CS) are first-line therapy for many neuromuscular diseases. Although long-term use is associated with many adverse effects, guidelines regarding prevention and management of CS-induced (CSI) complications in neurology are lacking, introducing potential practice variation. We aimed to evaluate Canadian neuromuscular neurologist practices for screening and management of CSI complications. Methods: A web-based anonymous questionnaire was disseminated to 99 Canadian neuromuscular neurologists addressing the screening, prevention, monitoring and treatment of CSI adverse effects, such as infection and osteoporosis. Results: 71% completed the survey. Of those, 52% perform screening blood work prior to initiating CS, 56.3% screen for infections, and 18.3% for osteoporosis. The majority monitor glycemic control and blood pressure. 28.6% never use pneumocystis jiroveci pneumonia prophylaxis, and 28.6% routinely recommend vaccinations prior to CS initiation (most commonly influenza and pneumococcal). 80.0% recommended calcium supplementation to prevent osteoporosis. 36% were unaware of any existing guidelines for preventing CSI complications, and 91% endorsed a need for neurology-specific guidelines. Additional data and details of responses will be presented. Conclusions: There is substantial variability in the management of CSI adverse effects among neuromuscular neurologists. This suggests a need for neurology-specific guidelines to help standardize practice.