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No significant evidences have been found to support the use of anabolic
steroids in treatment of pressure ulcers. Future well designed multicentre
studies are needed.
Pressure
ulcers, also called as bed sores that occurs over a bony prominence due to some
localized injury to the dermis or underlying tissue, or both. Anabolic steroids
are used as off-label drugs for a while now in the management of pressure
ulcers. These have been used as an adjuvant to natural therapy with dressings,
debridement, nutritional supplements, systemic antibiotics and antiseptics,
which are estimated to be supportive in the healing of pressure ulcers. The recent
2017 study by Whittaker and colleagues evaluated the effects
of anabolic steroids for treating pressure ulcers.
The
authors searched published or unpublished randomized controlled trials in March
2017 . The databases including Cochrane Wounds Specialized Register; the
Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE
(including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO
CINAHL Plus were searched. The randomized controlled trials (RCTs) included
were those, comparing the impacts of anabolic steroids with alternative
therapies or different types of anabolic steroids in the treatment of pressure
ulcers.
Two
authors independently did the study selection, data extraction and risk of bias
assessment.
Only
a single trial that had involved a total of 212 participants was found. This
trial examined the effects of an anabolic steroid (oxandrolone capsules) with a
placebo (dummy treatment containing no active medicine) on pressure ulcer
healing in people with spinal cord injuries. Most of the included participants
were male (98.2%) with a mean age of 58.4 years in the oxandrolone group. They
were comparable with the participants in the placebo group (male: 100%; mean
age: 57.3 years). The trial was carried over 24 weeks with a further follow-up
for eight weeks.
The
interim results of the analysis demonstrated that there was unlikely to be a
benefit from treatment with oxandrolone. As the data available is also limited
from one trial, it is not confirmed whether anabolic steroids can provide
beneficial effects on pressure ulcer healing. It is also uncertain that if
there will be increasingly severe adverse events with treatment. The procedure
may raise the risk of non-serious adverse events.
Overall,
the study concluded that no high-quality evidence support the use of anabolic
steroids in treating pressure ulcers. Further, there is a need of
well-designed, multicenter trials, at low risk of bias to analyse the impact of
anabolic steroids in the treatment of pressure ulcers. However, this requires a
careful consideration of the current test and its early termination is
necessary when planning the future research.
Cochrane Database of Systematic Reviews
Anabolic steroids for treating pressure ulcers
Cho Naing and Maxine A Whittaker
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