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Ambery P, Zajac G, Almquist J, Prothon S, Astbury C, Brown MN, Nemes S, Nsabimana J, Edman K, Öberg L, Lepistö M, Edenro G, Dillmann I, Mitra S, Belfield G, Keen C, Heise T. The effect of AZD9567 vs. prednisolone on glycaemic control in patients with type 2 diabetes mellitus: Results from a phase 2a clinical trial. Br J Clin Pharmacol 2024; 90:1921-1931. [PMID: 38690606 DOI: 10.1111/bcp.16082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
AIMS Corticosteroids are the treatment of choice for many inflammatory diseases but often lead to adverse effects, including hyperglycaemia. This study investigated the mechanisms driving differential effects on glucose control for AZD9567, an oral nonsteroidal selective glucocorticoid receptor modulator vs. prednisolone in 46 patients with type 2 diabetes mellitus. METHODS In this randomized, double-blind, 2-way cross-over study (NCT04556760), participants received either AZD9567 72 mg and prednisolone 40 mg daily (cohort 1); AZD9567 40 mg and prednisolone 20 mg daily (cohort 2); or placebo and prednisolone 5 mg daily (cohort 3). Treatment duration was 3 days with a 3-week washout between treatment periods. Glycaemic control was assessed after a standardized meal and with continuous glucose monitoring. RESULTS A significant difference between AZD9567 and prednisolone in favour of AZD9567 was observed for the change from baseline to Day 4 glucose excursions postmeal in cohort 1 (glucose area under the curve from 0 to 4 h -4.54%; 95% confidence interval [CI]: -8.88, -0.01; P = .049), but not in cohort 2 (-5.77%; 95% CI: -20.92, 12.29; P = .435). In cohort 1, significant differences between AZD9567 and prednisolone were also seen for the change from baseline to day 4 in insulin and glucagon secretion postmeal (P < .001 and P = .005, respectively) and change from baseline to Day 4 in GLP-1 response (P = .022). Significant differences between AZD9567 and prednisolone for 24-h glucose control were observed for both cohort 1 (-1.507 mmol/L; 95% CI: -2.0820, -0.9314; P < .001) and cohort 2 (-1.110 mmol/L; 95% CI -1.7257, -0.4941; P < .001). CONCLUSION AZD9567 significantly reduced treatment-induced hyperglycaemia compared with prednisolone.
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Affiliation(s)
- Philip Ambery
- Clinical Development, Research and Late Development, Cardiovascular, Renal and Metabolic Diseases, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Grzegorz Zajac
- Clinical Development, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | - Joachim Almquist
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Susanne Prothon
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Carol Astbury
- Projects Department, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Mary N Brown
- Clinical Development, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Boston, Massachusetts, USA
| | - Szilard Nemes
- Early Biometrics and Statistical Innovation, Statistics, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Joselyne Nsabimana
- Early Biometrics and Statistical Innovation, Statistical Programming, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Karl Edman
- Mechanistic and Structural Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Lisa Öberg
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Matti Lepistö
- Medicinal Chemistry, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Goran Edenro
- Respiratory, Inflammation and Autoimmunity BioScience, AstraZeneca, Gothenburg, Sweden
| | - Inken Dillmann
- Translational Genomics, Discovery Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Suman Mitra
- Canther, UMR9020 -CNRS-1277 -INSERM, F-59045, University de Lille, CHU de Lille, Lille, France
- IMED Respiratory, Inflammation and Autoimmunity, AstraZeneca, Gothenburg, Sweden
| | - Graham Belfield
- Translational Genomics, Discovery Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Christina Keen
- Clinical Development, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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Koshi EJ, Young K, Mostales JC, Vo KB, Burgess LP. Complications of Corticosteroid Therapy: A Comprehensive Literature Review. J Pharm Technol 2022; 38:360-367. [PMID: 36311302 PMCID: PMC9608099 DOI: 10.1177/87551225221116266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Relevance to Patient Care and Clinical Practice: Corticosteroids are among the most prescribed medications, particularly during the COVID-19 era. The literature has clearly highlighted the dangers of prolonged, high-dose corticosteroid use, which is important for clinicians to consider before treating patients in their clinical practices. Objective: The objective of this article is to review the literature on complications of corticosteroid use, review corticosteroid pharmacokinetics, and provide an updated reference on risks associated with corticosteroid therapy, especially at higher doses. Data Sources: A conventional literature search of PubMed was conducted without restrictions on publication date. Search terms included "corticosteroids," "avascular necrosis," "gastrointestinal bleeding," and "complications." Study Selection and Data Extraction: Pertinent systematic review/meta-analyses and randomized controlled trials were reviewed for study inclusion. Data Synthesis: Corticosteroids were associated with complications including avascular necrosis, gastrointestinal bleeding, myocardial infarction, heart failure, cerebrovascular events, diabetes mellitus, psychiatric syndromes, ophthalmic complications, tuberculosis reactivation, and bacterial sepsis. Increased daily and cumulative doses were associated with increased excess risk of complications. Cumulative doses greater than 430 mg prednisone equivalent were shown to increase the excess risk of avascular necrosis, with progressively higher rates with higher doses. Risk of gastrointestinal bleeding was significantly increased with corticosteroid usage in the in-patient but not out-patient setting. Conclusion: Since corticosteroids have been associated with the aforementioned severe complications and frequent medicolegal malpractice claims, counseling and informed consent should be performed when prescribing moderate-high dosages of corticosteroids. Further research is needed to characterize the long-term effects of corticosteroid usage in COVID-19 patients.
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Affiliation(s)
- Elliott J. Koshi
- John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Kurtis Young
- John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Joshua C. Mostales
- John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Kristine B. Vo
- John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Lawrence P. Burgess
- John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
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Mejía-Vilet JM, Ayoub I. The Use of Glucocorticoids in Lupus Nephritis: New Pathways for an Old Drug. Front Med (Lausanne) 2021; 8:622225. [PMID: 33665199 PMCID: PMC7921306 DOI: 10.3389/fmed.2021.622225] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
Glucocorticoids therapy has greatly improved the outcome of lupus nephritis patients. Since their discovery, their adverse effects have counterbalanced their beneficial anti-inflammatory effects. Glucocorticoids exert their effects through both genomic and non-genomic pathways. Differential activation of these pathways is clinically relevant in terms of benefit and adverse effects. Ongoing aims in lupus nephritis treatment development focus on a better use of glucocorticoids combined with immunosuppressant drugs and biologics. Newer regimens aim to decrease the peak glucocorticoid dose, allow a rapid glucocorticoid tapering, and intend to control disease activity with a lower cumulative glucocorticoid exposure. In this review we discuss the mechanisms, adverse effects and recent strategies to limit glucocorticoid exposure without compromising treatment efficacy.
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Affiliation(s)
- Juan M Mejía-Vilet
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico
| | - Isabelle Ayoub
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Alexaki VI, Henneicke H. The Role of Glucocorticoids in the Management of COVID-19. Horm Metab Res 2021; 53:9-15. [PMID: 33207372 PMCID: PMC7781662 DOI: 10.1055/a-1300-2550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by an infection with the novel coronavirus SARS-CoV-2, has resulted in a global pandemic and poses an emergency to public health systems worldwide. COVID-19 is highly infectious and is characterized by an acute respiratory illness that varies from mild flu-like symptoms to the life-threatening acute respiratory distress syndrome (ARDS). As such, there is an urgent need for the development of new therapeutic strategies, which combat the high mortality in severely ill COVID-19 patients. Glucocorticoids are a frontline treatment for a diverse range of inflammatory diseases. Due to their immunosuppressive functions, the use of glucocorticoids in the treatment of COVID-19 patients was initially regarded with caution. However, recent studies concluded that the initiation of systemic glucocorticoids in patients suffering from severe and critical COVID-19 is associated with lower mortality. Herein we review the anti-inflammatory effects of glucocorticoids and discuss emerging issues in their clinical use in the context of COVID-19.
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Affiliation(s)
- Vasileia Ismini Alexaki
- Institute for Clinical Chemistry and Laboratory Medicine, Faculty of Medicine and University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Holger Henneicke
- Center for Regenerative Therapies Dresden, TU Dresden, Dresden, Germany
- Department of Medicine III & Center for Healthy Aging, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
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Zhang T, Liang Y, Zhang J. Natural and synthetic compounds as dissociated agonists of glucocorticoid receptor. Pharmacol Res 2020; 156:104802. [DOI: 10.1016/j.phrs.2020.104802] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
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Methotrexate as an Adjuvant in Severe Thyroid Eye Disease: Does It Really Work as a Steroid-Sparing Agent? Ophthalmic Plast Reconstr Surg 2019; 35:369-373. [PMID: 30624412 DOI: 10.1097/iop.0000000000001279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare the efficacy and safety of adjunctive oral methotrexate with intravenous pulsed methylprednisolone against methylprednisolone alone in the treatment of severe thyroid eye disease. METHODS Retrospective review of clinical data of patients with severe sight-threatening thyroid eye disease with compressive optic neuropathy treated with methylprednisolone with and without methotrexate. Eye disease outcome measures (e.g., VISA inflammatory score and vision) at 0, 3, 6, 12, and 18 months were recorded. RESULTS There were 72 subjects including 33 who had methylprednisolone alone and 39 with methylprednisolone with methotrexate. There were no statistical differences in demographics and baseline measures of disease activity or vision between the 2 treatment groups. No significant statistical differences in the cumulative dosage of methylprednisolone or occurrence of restrictive myopathy, raised intraocular pressure, proptosis, and exposure keratopathy between the groups at 0, 3, 6, 12, and 18 months were found. However, subjects who received methylprednisolone with methotrexate had better visual acuity of more than 2 lines on Snellen chart (p = 0.026) and VISA inflammatory score (p = 0.034) at 3 months, but no differences at 6, 12, and 18 months. Three patients who received methylprednisolone with methotrexate had transient worsening of liver function. No patient developed severe adverse reaction. CONCLUSIONS The results demonstrated improved vision and disease activity at 3 months in the combination treatment group. This may suggest that the addition of methotrexate to methylprednisolone is beneficial for accelerating suppression of disease activity and hastens visual recovery. Addition of methotrexate to methylprednisolone did not reduce the requirement for steroids.
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Gheisari M, Faraji Z, Dadras MS, Nasiri S, Robati RM, Moravvej H, Tehranchinia Z, Ghalamkarpour F, Namazi N, Nobari NN. Methylprednisolone pulse therapy plus adjuvant therapy for pemphigus vulgaris: an analysis of 10 years' experience on 312 patients. Dermatol Ther 2019; 32:e13057. [PMID: 31400243 DOI: 10.1111/dth.13057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 01/22/2023]
Abstract
Steroid pulse therapy has shown satisfactory efficacy and safety in treating pemphigus vulgaris (PV). However, there is a paucity of data about the efficacy and safety of methylprednisolone, despite its frequent administration. The aim of this study is to evaluate the efficacy and safety of steroid pulse therapy in treating PV. In this 10-year retrospective cohort study, 312 patients with PV, who had received methylprednisolone pulse therapy, were included. Data of pulse therapy sessions, adjuvant medications, dosages, remission rates, complications, and mortalities were collected from all patients. A total of 276 patients out of 312 underwent the final follow-up at least 6 months after the last session of pulse therapy. Complete remission off therapy was achieved in 83 patients (30%), and 152 patients (55%) had complete remission on therapy. About 29 (10.5%) patients had lesions of pemphigus at the time of the study follow-up, and 26.8% of remained patients were on the minimal therapy. Methylprednisolone pulse therapy could be considered as an option for proper control of PV in severe cases. It might lead to shorter periods of hospitalization and reduce the need to take long-term high-dose oral steroid therapy.
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Affiliation(s)
- Mehdi Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Faraji
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad S Dadras
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Nasiri
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Moravvej
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Tehranchinia
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghalamkarpour
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Namazi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar N Nobari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Risk Factor Analysis for the Outcomes of Indirect Traumatic Optic Neuropathy with No Light Perception at Initial Visual Acuity Testing. World Neurosurg 2018; 115:e620-e628. [PMID: 29705230 DOI: 10.1016/j.wneu.2018.04.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The optimal management of indirect traumatic optic neuropathy (TON) is controversial. We aimed to compare the differences in visual improvement by treatment option in patients presenting with TON and no light perception (NLP). We also wanted to identify any patient-related factors that might favor the use of steroid pulse therapy or optic nerve decompression (OND). METHODS We retrospectively identified 46 consecutive patients with indirect TON treated at Chang Gung Memorial Hospital between 2007 and 2015. The outcome was the improvement in visual acuity by improvement rate and degree of improvement. RESULTS Females had a better improvement rate than did males. Compared with delayed treatment, patients receiving steroid pulse therapy within 14 hours or receiving OND within 26 hours had a better improvement rate/degree. In patients with an initial intraocular pressure (IOP) of 17-23 mm Hg, the improvement rate/degree was significantly better than for patients with an IOP outside this range. For patients treated by OND, an initially normal IOP (11-21 mm Hg) suggested a significantly better prognosis in the improvement rate/degree. CONCLUSIONS For patients with indirect TON, initial NLP implies a poor prognosis, but steroid pulse therapy or OND are both feasible treatment options. These results emphasize the importance of timely treatment for patients with indirect TON and NLP. Females and patients with an initial IOP of 17-23 mm Hg were more likely to recover. The results of our study indicate that normal initial IOP (11-21 mm Hg) is good prognostic factor for patients with indirect TON treated with OND.
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Risk Factors Analysis for the Outcome of Indirect Traumatic Optic Neuropathy With Steroid Pulse Therapy. Ann Plast Surg 2016; 76 Suppl 1:S60-7. [PMID: 26808764 DOI: 10.1097/sap.0000000000000694] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although recent evidence suggests a controversy effect of steroids in the management of indirect traumatic optic neuropathy (TON), steroid pulse therapy remains one of the reasonable treatments for patients with indirect TON. It is thought that microcirculatory spasms, edema, and nerve cell necrosis can be prevented or reduced by large doses of steroids. The aim of this study is to analyze the predisposing factors for the recovery of patients with indirect TON who were treated with steroid pulse therapy. MATERIALS AND METHODS In tracing the 2008 to 2014 data from the Trauma Center of Chang Gung Memorial Hospital, 20 consecutive cases of indirect TON were identified retrospectively. Twenty cases showed no light perception (NLP) under initial ophthalmologic examination. They all received steroid pulse therapy with methylprednisolone in IV form after examination by ophthalmologists, and they did not receive optic nerve decompression. The general data, fracture pattern from images, hospital courses, trauma-related data from ER record, and the initial and final visual data from ophthalmologic records are reviewed. The odds ratio (OR) and 95% confidence intervals (CI) are calculated. Fisher exact test is used for 2 variables to test differences between proportions. Nonparametric statistics are applied to compare the mean values of the data. RESULTS The results show that for female patients (OR, 3.400; 95% CI, 1.628-7.101; P = 0.049), the administration of methylprednisolone in less than 24 hours from the injury (OR, 3.429; 0.297-39.637), lateral force fracture pattern (OR, 3.500; 0.313-39.153), age of 40 years or younger (OR, 2.333; 0.197-27.567), and pure facial trauma (OR, 3.667; 0.273-49.288) are the predisposing factors for improvement of visual acuity. Patients with orbital blowout fractures (OR, 9.800; 95% CI, 0.899-106.845; P = 0.070), initial free extraocular movement (EOM) (OR, 6.667; 0.809-54.597; P = 0.145), initial intraoptic pressure (IOP) greater than 25 mmHg (OR, 8.000; 0.598-106.936), and higher triage grade (OR, 3.000; 0.447-20.153) are at risk of showing no improvement. CONCLUSIONS From this study, we might suggest to apply steroid pulse therapy on those patients without contraindication, with an incurring injury less than 24 hours previously. Factors such as sex, age, lateral force fracture pattern, and pure facial trauma revealed a better outcome for improvement of visual acuity. Orbital blowout fractures, initial free EOM, initial IOP greater than 25 mmHg, and higher triage grade suggested poor improvement of visual acuity.
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Vital to monitor, prevent and treat metabolic and cardiovascular adverse events induced by long-term systemic glucocorticoid therapy. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yong KL, Chng CL, Htoon HM, Lim LH, Seah LL. Safety Profile and Effects of Pulsed Methylprednisolone on Vital Signs in Thyroid Eye Disease. Int J Endocrinol 2015; 2015:457123. [PMID: 26681940 PMCID: PMC4670667 DOI: 10.1155/2015/457123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/19/2022] Open
Abstract
Objective. To analyze changes in vital signs (heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP)) during and after intravenous methylprednisolone (IVMP) and any other adverse effects. Methods. Retrospective review of charts of patients who received IVMP as treatment regime for thyroid eye disease. All subjects had vital signs charted during and after infusions. Results. This study included 38 subjects and a total of 242 infusions administered. IVMP resulted in a small but significant percentage drop in mean SBP at 30 min (p < 0.001) and 60 min (p = 0.03) but no difference at 90 min. There was also small but significant percentage drop in mean DBP and HR (DBP: p < 0.001 for 30 min, p = 0.001 for 60 min, and p = 0.02 for 90 min and HR: p < 0.001 for 30 min, 60 min, and 90 min). There were no cumulative effects on change of blood pressure or HR. There were 6 episodes of bradycardia (2.5%) and 12 episodes of moderate to severe hypertension (5%). No significant cardiovascular or hepatic toxicity was found. Conclusion. IVMP is relatively safe and efficacious. IVMP demonstrated mild and noncumulative effects on vital signs. Severe hypertension may occur in susceptible individuals such as those with underlying hypertension and uncontrolled thyroid dysfunction, whereas bradycardia may be more likely in those on beta-blockers.
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Affiliation(s)
- Kai-Ling Yong
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751
- *Kai-Ling Yong:
| | - Chiaw Ling Chng
- Singapore General Hospital, Outram Road, Singapore 169608
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857
| | - Hla Myint Htoon
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751
| | - Lee Hooi Lim
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751
| | - Lay Leng Seah
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore 119228
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Fardet L, Fève B. Systemic Glucocorticoid Therapy: a Review of its Metabolic and Cardiovascular Adverse Events. Drugs 2014; 74:1731-45. [DOI: 10.1007/s40265-014-0282-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Complications de la corticothérapie chez les patients souffrant de maladie de Horton ou de pseudopolyarthrite rhizomélique. Rev Med Interne 2013; 34:438-43. [DOI: 10.1016/j.revmed.2013.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 12/11/2022]
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Fardet L. Effets indésirables métaboliques et cardiovasculaires des corticothérapies systémiques. Rev Med Interne 2013; 34:303-9. [DOI: 10.1016/j.revmed.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/10/2012] [Indexed: 02/07/2023]
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Park JH, Shin JP, Chun BY. Additional Retrobulbar Triamcinolone Acetonide Injection for Retrobulbar Optic Neuritis Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Joon Ho Park
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Bo Young Chun
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Abstract
Multiple sclerosis (MS) is a chronic progressive inflammatory demyelinating disease affecting the central nervous system. The most common clinical type of MS tends to follow a relapsing course, affecting the vast majority of patients living with this disease. Relapses are a hallmark of MS, and are often associated with significant functional impairment and decreased quality of life. Although usually followed by a period of remission, residual symptoms after MS relapses may persist and lead to sustained disability. Adequate management of MS relapses is important, as it may help to shorten and lessen the disability associated with their course. Historically, treatment of MS relapse was the first approach (and for a period of time, the only approach) to MS treatment in general. Systemic corticosteroids and adrenocorticotropic hormone (ACTH) have broad regulatory approval and remain the most established and validated treatment options for MS relapse. Therapeutic mechanisms of ACTH were previously associated (perhaps mistakenly) with only corticotropic actions; however, recently the direct anti-inflammatory effects and immunomodulatory activity of ACTH gel acting through melanocortin pathways have been shown. Second-line treatments of steroid-unresponsive MS relapses and a possible algorithm for MS relapse management are also reviewed in this article.
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Affiliation(s)
- Regina Berkovich
- Multiple Sclerosis Center and Research Group, Keck School of Medicine, University of Southern California Neurology, University of Southern California, Los Angeles, CA 90033, USA.
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Hypothalamic-pituitary-adrenal axis function following intravitreal triamcinolone acetonide injection. Int Ophthalmol 2012; 33:211-6. [PMID: 23132214 DOI: 10.1007/s10792-012-9659-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 10/11/2012] [Indexed: 01/15/2023]
Abstract
To evaluate the pituitary-adrenal axis function by means of the adrenocorticotropic hormone (ACTH) stimulation test following a single intravitreal injection of triamcinolone acetonide (IVTA). Prospective comparative clinical interventional study. Twenty-eight patients (28 eyes) received a single IVTA (4 mg in 0.1 ml) for macular edema. The basal cortisol level and the response to 1 μg adrenocorticotropic hormone stimulation were determined on the morning before IVTA injection and at 1 day and 1, 2, and 4 weeks after IVTA injection. Results were compared with those obtained from a control group of 50 healthy subjects. All patients in the study had normal basal cortisol and normal response to ACTH challenge before receiving IVTA. 1 day following IVTA, basal cortisol was suppressed in one patient in the study group. Fasting serum cortisol levels at 1, 2, and 4 weeks after IVTA injection were normal in all patients in the study group. 1 day following IVTA, the peak response to ACTH at 30 min was blunted in four patients (14.3 % of the study group, p = 0.05) and the cortisol response at 60 min was suppressed (p = 0.009). 1 week following IVTA, the response to ACTH challenge was blunted in only one patient. A single IVTA injection may be associated with impaired hypothalamic-pituitary-adrenal function in some patients during the first 24 h following IVTA.
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[Corticosteroids and diabetes mellitus]. Presse Med 2012; 41:393-9. [PMID: 22361026 DOI: 10.1016/j.lpm.2012.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/07/2012] [Accepted: 01/10/2012] [Indexed: 11/23/2022] Open
Abstract
During corticosteroid prescriptions, diabetes mellitus may be completely deregulated or may be revealed as such. Predisposition to diabetes mellitus could be because of latent β Langerhans cell deregulation or because enhancement of tissue sensitivity by glucocorticosteroids. However, epidemiologic data concerning predisposing factors and frequency of cortico-induced diabetes are not well known. Detection, treatment and prevention are the same as for type II diabetes. Glycemia should be monitored throughout long-term treatments.
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Zaka-ur-Rab S, Mahmood S, Shukla M, Zakir SM, Khan BA, Owais M. Systemic absorption of triamcinolone acetonide after posterior sub-Tenon injection. Am J Ophthalmol 2009; 148:414-9. [PMID: 19464668 DOI: 10.1016/j.ajo.2009.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 03/22/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To study systemic absorption of triamcinolone acetonide (TA) after posterior sub-Tenon injection. DESIGN Prospective, interventional case series. METHODS The study was conducted in a tertiary care teaching hospital on 35 eyes in which posterior sub-Tenon injection of 40 mg TA was administered after conventional extracapsular cataract extraction. Patients who had received any systemic steroid over 6 weeks preceding the period of study or had inflammatory ocular conditions were excluded. Serum TA levels were estimated by high-performance liquid chromatography at 1, 2, 3, 24, and 48 hours and 1, 2, and 6 weeks after injection. RESULTS Significant levels of the drug were detected in 45.71% of samples (mean serum levels, 6.94 +/- 8.98 ng/ml; P < .001) at 1 hour after sub-Tenon injection, in 85.71% of samples (mean serum levels, 21.83 +/- 12.92 ng/ml; P < .001) at 2 hours after injection, in 100% of samples (mean serum levels, 47.14 +/- 12.20 ng/ml; P < .001) at 3 hours after injection, in 100% of samples (mean serum levels, 35.49 +/- 13.79 ng/ml; P < .001) at 24 hours after injection, in 62.86% of samples (mean serum levels, 10.46 +/- 10.69 ng/ml; P < .001) at 48 hours after injection, and in 28.57% of samples (mean serum levels, 3.74 +/- 6.45 ng/ml; P = .002) at 1 week after injection. The drug was not detected in any of the samples obtained 2 weeks and 6 weeks later. CONCLUSIONS Posterior sub-Tenon injection of 40 mg TA adds statistically significant quantities to physiologic concentration of corticosteroids in peripheral blood. This may be detrimental for patients having certain metabolic diseases like diabetes and preferably should be avoided or administered with caution.
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Feldman-Billard S, Héron E. Tolérance systémique des corticoïdes en ophtalmologie : influence de la voie d’administration. J Fr Ophtalmol 2008; 31:1026-36. [DOI: 10.1016/s0181-5512(08)74751-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ji Yeon K, Ahn M. Side Effects of Intravenous Methylprednisolone Pulse Therapy in Eye Diseases. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.1.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kim Ji Yeon
- Department of Ophthalmology, Chonbuk National University, College of Medicine, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University, College of Medicine, Jeonju, Korea
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Fardet L, Kassar A, Cabane J, Flahault A. Corticosteroid-induced adverse events in adults: frequency, screening and prevention. Drug Saf 2007; 30:861-81. [PMID: 17867724 DOI: 10.2165/00002018-200730100-00005] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Corticosteroids represent the most important and frequently used class of anti-inflammatory drugs and are the reference therapy for numerous neoplastic, immunological and allergic diseases. However, their substantial efficacy is often counter-balanced by multiple adverse events. These corticosteroid-induced adverse events represent a broad clinical and biological spectrum from mild irritability to severe and life-threatening adrenal insufficiency or cardiovascular events. The purpose of this article is to provide an overview of the available data regarding the frequency, screening and prevention of the adverse events observed in adults during systemic corticosteroid therapy (topically administered corticosteroids are outside the remit of this review). These include clinical (i.e. adipose tissue redistribution, hypertension, cardiovascular risk, osteoporosis, myopathy, peptic ulcer, adrenal insufficiency, infections, mood disorders, ophthalmological disorders, skin disorders, menstrual disorders, aseptic necrosis, pancreatitis) and biological (i.e. electrolytes homeostasis, diabetogenesis, dyslipidaemia) events. Lastly, data about the prescription of corticosteroids during pregnancy are provided. This review underscores the absence of data on many of these adverse events (e.g. lipodystrophy, dyslipidaemia). Our intent is to present to practitioners data that can be used in a practical way to both screen and prevent most of the adverse events observed during systemic corticosteroid therapy.
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Affiliation(s)
- Laurence Fardet
- Department of Internal Medicine, Hôpital Saint Antoine, Paris, France.
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Feldman-Billard S, Du Pasquier-Fediaevsky L, Héron E. Hyperglycemia after repeated periocular dexamethasone injections in patients with diabetes. Ophthalmology 2006; 113:1720-3. [PMID: 17011953 DOI: 10.1016/j.ophtha.2006.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 03/24/2006] [Accepted: 05/17/2006] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To assess the hyperglycemic effect of 3 consecutive daily periocular steroid injections in patients with diabetes. DESIGN Retrospective observational study in a national eye center. PARTICIPANTS Twenty-five hospitalized patients with type 2 diabetes who received a subconjunctival (n = 11) or a peribulbar injection (n = 14) with 4 mg dexamethasone disodium phosphate once a day for 3 consecutive days for ocular conditions. METHODS Baseline patient characteristics were recorded as well as serial blood glucose measurements and hypoglycemic interventions, both performed according to a written protocol. MAIN OUTCOME MEASURES Serial blood glucose measurements and hypoglycemic interventions. RESULTS Each ocular injection with dexamethasone was followed around 6 hours later by an increase of blood glucose up to a median doubling from baseline (+100% increase) followed by falls until the next injection, toward a median 13% increase from baseline before the next ocular injection. Older age (P<0.05), duration of diabetes (P = 0.01), and microangiopathy or macroangiopathy (P = 0.01) were associated with higher blood glucose rises. Using a 14-mmol/l threshold for intervention, the probability of requiring additional hypoglycemic treatment during ocular steroid therapy in patients with HbA1c >7.5% and up to 7.5% was 100% and 60%, respectively. CONCLUSIONS Periocular injections with dexamethasone in patients with type 2 diabetes induce a marked hyperglycemic effect, similar to that observed during intravenous pulse methylprednisolone.
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Affiliation(s)
- Sylvie Feldman-Billard
- Service de Médecine Interne, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
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Gursoy A, Cesur M, Erdogan MF, Corapcioglu D, Kamel N. New-onset acute heart failure after intravenous glucocorticoid pulse therapy in a patient with Graves' ophthalmopathy. Endocrine 2006; 29:513-6. [PMID: 16943591 DOI: 10.1385/endo:29:3:513] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 01/19/2006] [Accepted: 01/20/2006] [Indexed: 11/11/2022]
Abstract
A 53-yr-old previously healthy man was admitted to our hospital for thyrotoxicosis without ophthalmopathy. Initial therapy with propylthiouracil caused an acute elevation of liver enzymes. Then, he received a first course of 131I therapy (20 mCi). At the end of 6-mo follow-up after 131I, he was still thyrotoxic and developed moderately severe ophthalmopathy. The patient refused thyroid surgery and decided to undergo second course of 131I therapy (30 mCi). Concomitantly with the 131I, we opted to give high-dose pulse glucocorticoid therapy (PGT) to prevent further deterioration of GO. The patient was started on intravenous methylprednisolone pulse therapy 1 g daily in a cycle (one cycle every 2 wk, each cycle comprising two infusions on alternate days). After the end of the second day of PGT administration, he suddenly developed onset of acute pulmonary edema and hypertension. There was no previous history of cardiac disorder or conditions predisposing to cardiac failure other than thyrotoxicosis. A presumptive diagnosis of fluid overload and/or hypertension- induced acute heart failure was made. After prompt investigations excluding cardiogenic causes, we thought that this condition was triggered by PGT that was superimposed on thyrotoxicosis-related hemodynamic instability. Graves' patients with uncontrolled thyrotoxicosis should be under careful surveillance when PGT is planned. To our knowledge, this is the first reported case of life-threatening acute pulmonary edema caused by PGT in GO.
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Affiliation(s)
- Alptekin Gursoy
- Department of Endocrinology and Metabolic Diseases, Ankara University, School of Medicine, Ankara, Turkey
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Markomichelakis NN, Halkiadakis I, Papaeythymiou-Orchan S, Giannakopoulos N, Ekonomopoulos N, Kouris T. Intravenous pulse methylprednisolone therapy for acute treatment of serpiginous choroiditis. Ocul Immunol Inflamm 2006; 14:29-33. [PMID: 16507488 DOI: 10.1080/09273940500227192] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of high-dose intravenous steroid therapy (HDIST) for the acute treatment of vision-threatening serpiginous choroiditis. METHODS Retrospective review of the records of five patients with serpiginous choroiditis who were treated with HDIST (1 g methylprednisolone for three days) in addition to their standard immunosuppressive treatment. The visual acuities and improvement of ocular signs after HDIST were evaluated. RESULTS Twelve episodes of macula-threatening choroiditis in five patients with serpiginous choroiditis were treated during a seven-year period. All patients responded to HDIST with evidence of a decrease in intraocular inflammation immediately after and complete restoration of visual acuity within 10 days of commencing treatment. In one patient, medical intervention was required because of gastric distress. During the follow-up, three out of five patients experienced new attacks and two patients developed subretinal neovascularization. CONCLUSION HDIST is effective in controlling severe vision-threatening serpiginous choroiditis and in improving visual function in a short period of time. However, the effect of this treatment in long-term disease control is uncertain.
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Affiliation(s)
- Nikos N Markomichelakis
- Ocular Immunology and Inflammation Service, General Hospital of Athens, Department of Ophthalmology, Athens, Greece.
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