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Samdaengpan C, Sungkasubun P, Chaiwiriyawong W, Supavavej A, Siripaibun J, Phanthunane C, Tantiyavarong W, Lamlertthon W, Ungtrakul T, Tawinprai K, Soonklang K, Thongchai T, Limpawittayakul P. Effect of Corticosteroid on Immunogenicity of SARS-CoV-2 Vaccines in Patients With Solid Cancer. JCO Glob Oncol 2024; 10:e2300458. [PMID: 38781552 DOI: 10.1200/go.23.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Corticosteroids are known to diminish immune response ability, which is generally used in routine premedication for chemotherapy. The intersecting of timeframe between the corticosteroid's duration of action and peak COVID-19 vaccine efficacy could impair vaccine immunogenicity. Thus, inquiring about corticosteroids affecting the efficacy of vaccines to promote effective immunity in this population is needed. METHODS This was a prospective longitudinal observational cohort study that enrolled patients with solid cancer classified into dexamethasone- and nondexamethasone-receiving groups. All participants were immunized with two doses of ChAdOx1 nCoV-19 or CoronaVac vaccines. This study's purpose was to compare corticosteroid's effect on immunogenicity responses to the SARS-CoV-2 S protein in patients with cancer after two doses of COVID-19 vaccine in the dexamethasone and nondexamethasone group. Secondary outcomes included the postimmunization anti-spike (S) immunoglobin G (IgG) seroconversion rate, the association of corticosteroid dosage, time duration, and immunogenicity level. RESULTS Among the 161 enrolled patients with solid cancer, 71 and 90 were in the dexamethasone and nondexamethasone groups, respectively. The median anti-S IgG titer after COVID-19 vaccination in the dexamethasone group was lower than that in the nondexamethasone group with a statistically significant difference (47.22 v 141.09 U/mL, P = .035). The anti-S IgG seroconversion rate was also significantly lower in the dexamethasone group than in the nondexamethasone group (93.83% v 80.95%, P = .023). The lowest median anti-SARS-CoV-2 IgG titer level at 7.89 AU/mL was observed in patients with the highest dose of steroid group (≥37 mg of dexamethasone cumulative dose throughout the course of chemotherapy [per course]) and patients who were injected with COVID-19 vaccines on the same day of receiving dexamethasone, 25.41 AU/mL. CONCLUSION Patients with solid cancer vaccinated against COVID-19 disease while receiving dexamethasone had lower immunogenicity responses than those who got vaccines without dexamethasone. The direct association between the immunogenicity level and steroid dosage, as well as length of duration from vaccination to dexamethasone, was observed.
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Affiliation(s)
- Chayanee Samdaengpan
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Prakongboon Sungkasubun
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Worawit Chaiwiriyawong
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Archara Supavavej
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jomtana Siripaibun
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chumut Phanthunane
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Walaipan Tantiyavarong
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wisut Lamlertthon
- Faculty of Medicine and Public Health, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kriangkrai Tawinprai
- Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kamonwan Soonklang
- Chulabhorn Learning and Research Center, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Thitapha Thongchai
- Chulabhorn Learning and Research Center, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Piyarat Limpawittayakul
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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Zheng P, Hao D, Christolias G, Marshall B, Smith CC, Sudhakaran S, Patel J, McCormick ZL. FactFinders for patient safety: Delaying epidural steroid injections: Infection and safe platelet cutoff. INTERVENTIONAL PAIN MEDICINE 2024; 3:100383. [PMID: 39239505 PMCID: PMC11372875 DOI: 10.1016/j.inpm.2024.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 09/07/2024]
Abstract
This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of patients with potential contraindications to epidural steroid injections.
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Affiliation(s)
- Patricia Zheng
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - David Hao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George Christolias
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, NY, USA
| | - Ben Marshall
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Denver, CO, USA
| | - Clark C Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, NY, USA
| | | | - Jaymin Patel
- Emory University, Department of Orthopaedics, Atlanta, GA, USA
| | - Zachary L McCormick
- University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
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Evangelidis D, Jeong S, Lin G, Ehigie N, Hamilton P, Sott A, Yousaf S. Are foot and ankle corticosteroid injections safe during the COVID-19 pandemic? A single center prospective observational study. Foot (Edinb) 2023; 56:102001. [PMID: 37027900 PMCID: PMC10014129 DOI: 10.1016/j.foot.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Intra-articular corticosteroid injections (ICSI) are commonly used in orthopedic practice. Due to concerns about their immunosuppressive effects, we conducted a prospective observational audit, to monitor for COVID-19 infection amongst a group of foot and ankle patients who received an ICSI during the pandemic. PATIENTS AND METHODS Included were 68 patients (25 males - 43 females, mean age 59.1 years, SD 15.0, range 19 - 90 years) who received a fluoroscopy-guided ICSI within a two-month period during the pandemic. The American Society of Anaesthesiologists (ASA) grade was I in 35 % of patients, II in 58 % and III in 7 %. 16 % of patients had black, Asian or minority ethnic (BAME) background. The dose of methylprednisolone injected was 20 mg for 28 % of the patients, 40 mg for 29 % and 80 mg for 43 %. RESULTS All patients were available for follow up at one and four weeks post-injection. None reported COVID-19 infection symptoms within this period. The only complication was a flare-up of joint pain. CONCLUSION Our study showed that the risk of COVID-19 infection to patients receiving foot or ankle ICSI is low. The limitations of this work must be considered, but our findings support the judicious use of corticosteroid injections during the current crisis.
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Affiliation(s)
| | - Su Jeong
- St George's University of London, UK.
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Okçu M, Azizov S, Gündüz OH, Şencan S. Incidence and Disease Course of COVID-19 Infection Among Unvaccinated Patients Who Received Local Corticosteroid Injections. Am J Phys Med Rehabil 2023; 102:347-352. [PMID: 36730743 PMCID: PMC10010666 DOI: 10.1097/phm.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There are concerns that local corticosteroid injections may increase the risk of COVID-19 infection because of the immunosuppressive effect of corticosteroids. This study aimed to examine the relationship between local corticosteroid injections and the risk of COVID-19 infection. DESIGN The date and type of procedure as well as the dose and type of corticosteroids used in patients who underwent local corticosteroid injections within 1 yr after the first COVID-19 case in the country were examined retrospectively and recorded. Patients who did not receive corticosteroids were included in the control group. Coronavirus disease 2019 infection histories of all patients were recorded. RESULTS There was no significant difference between the patients who received local corticosteroids and the control group in terms of the incidence of COVID-19 infections, and the number of patients who needed hospitalization or intensive care treatment. In addition, it was found that the administration of two injections, the type of procedure performed, and the dose and type of steroids were not associated with the incidence or severity of COVID-19 infections. CONCLUSIONS It has been shown that local corticosteroid injections are not associated with the incidence of COVID-19 infections and the number of patients who need hospitalization or intensive care treatment due to COVID-19.
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Whelan G, Sim J, Smith B, Moffatt M, Littlewood C. Are Corticosteroid Injections Associated With Secondary Adrenal Insufficiency in Adults With Musculoskeletal Pain? A Systematic Review and Meta-analysis of Prospective Studies. Clin Orthop Relat Res 2022; 480:1061-1074. [PMID: 35302533 PMCID: PMC9263464 DOI: 10.1097/corr.0000000000002145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Corticosteroid injection is a common treatment for individuals experiencing musculoskeletal pain, and it is part of the management of numerous orthopaedic conditions. However, there is concern about offering corticosteroid injections for musculoskeletal pain because of the possibility of secondary adrenal insufficiency. QUESTIONS/PURPOSES In this systematic review and meta-analysis of prospective studies, we asked: (1) Are corticosteroid injections associated with secondary adrenal insufficiency as measured by 7-day morning serum cortisol? (2) Does this association differ depending on whether the shot was administered in the spine or the appendicular skeleton? METHODS We searched the Allied and Complementary Medicine (AMED), Embase, EmCare, MEDLINE, CINAHL, and Web of Science from inception to January 22, 2021. We retrieved 4303 unique records, of which 17 were eventually included. Study appraisal was via the Downs and Black tool, with an average quality rating of fair. A Grading of Recommendations, Assessment, Development, and Evaluations assessment was conducted with the overall certainty of evidence being low to moderate. Reflecting heterogeneity in the study estimates, a pooled random-effects estimate of cortisol levels 7 days after corticosteroid injection was calculated. Fifteen studies or subgroups (254 participants) provided appropriate estimates for statistical pooling. A total of 106 participants received a spine injection, and 148 participants received an appendicular skeleton injection, including the glenohumeral joint, subacromial bursa, trochanteric bursa, and knee. RESULTS Seven days after corticosteroid injection, the mean morning serum cortisol was 212 nmol/L (95% confidence interval 133 to 290), suggesting that secondary adrenal insufficiency was a possible outcome. There is a difference in the secondary adrenal insufficiency risk depending on whether the injection was in the spine or the appendicular skeleton. For spinal injection, the mean cortisol was 98 nmol/L (95% CI 48 to 149), suggesting secondary adrenal insufficiency was likely. For appendicular skeleton injection the mean cortisol was 311 nmol/L (95% CI 213 to 409) suggesting hypothalamic-pituitary-adrenal axis integrity was likely. CONCLUSION Clinicians offering spinal injections should discuss the possibility of short-term secondary adrenal insufficiency with patients, and together, they can decide whether the treatment remains appropriate and whether mitigation strategies are needed. Clinicians offering appendicular skeleton injections should not limit care because of concerns about secondary adrenal insufficiency based on the best available evidence, and clinical guidelines could be reviewed accordingly. Further research is needed to understand whether age and/or sex determine risk of secondary adrenal insufficiency and what clinical impact secondary adrenal insufficiency has on patients undergoing spinal injection. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Gareth Whelan
- Musculoskeletal Department, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Julius Sim
- School of Medicine, Keele University, Keele, UK
| | - Benjamin Smith
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, UK
| | - Maria Moffatt
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Chris Littlewood
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Vogel F, Reincke M. Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess. Rev Endocr Metab Disord 2022; 23:233-250. [PMID: 34241765 PMCID: PMC8267234 DOI: 10.1007/s11154-021-09670-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 01/08/2023]
Abstract
Patients with endogenous or exogenous glucocorticoid (GC) excess exhibit a range of side effects, including an increased risk of infections. Via both mechanism, immune impairments and cardiometabolic concomitant diseases, patients with GC excess could be at increased risk for COVID-19. The impact on incidence and outcome of a SARS-CoV-2 infection in this population are not yet completely clear. This review aims to compile the data available to date and to discuss the existing literature on this topic. Further we highlight potential effects of SARS-CoV-2 on the hypothalamic-pituitary-adrenal axis as well as the influence of endogenous or exogenous GC excess on SARS-CoV-2 mRNA vaccination. There is growing evidence suggesting an increased risk of infection and severe outcome in patients with high-dose GC therapy after contracting SARS-CoV-2. The few data and case reports on patients with endogenous GC excess and SARS-CoV-2 infection point in a similar direction: chronic GC excess seems to be associated with an unfavorable course of COVID-19. Whether this is mainly a primary immune-mediated effect, or also triggered by the many GC-associated comorbidities in this population, is not yet fully understood. Patients with endogenous or exogenous GC excess should be considered as a vulnerable group during the SARS-CoV-2 pandemic. Regardless of the cause, vaccination and consistent surveillance and control of associated comorbidities are recommended.
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Affiliation(s)
- Frederick Vogel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany.
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Guerrero M, Castroman P, Quiroga O, Berenguel Cook M, Narvaez Tamayo MA, Venturoni L, Pergolizzi Jr J, Rekatsina M, Varrassi G. Pain Management and COVID-19: A Latin American Perspective. Cureus 2022; 14:e23100. [PMID: 35464506 PMCID: PMC9001811 DOI: 10.7759/cureus.23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/12/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccinations and therapeutics have been developed for COVID-19, but vaccine uptake varies markedly among countries. Public health responses have also varied, in particular, with lockdown efforts and school closing. All over the world, the pandemic exposed healthcare and economic weaknesses. COVID-19 exacerbated mental health issues by exposing the population to prolonged periods of fear, anxiety, financial stress, psychological uncertainties, and sometimes isolation from even family and friends. Chronic pain patients have been disproportionately affected. The pandemic-associated stresses may have exacerbated their already painful symptoms while at the same time interrupting their access to care. The ramifications of the COVID-19 post-viral syndrome (“long COVID-19”) are not yet known. COVID-19 viral infection has been associated with neuropathic pain symptoms. Tele-triage and telehealth applications can help manage chronic pain patients in the COVID-19 era, but many interventional procedures, injections, or other treatments have been delayed. The role of palliative care for patients with terminal cases of infection must be re-examined. Palliative care is a relatively new medical specialty and allows terminally ill patients to die in as much comfort and peace as can be afforded to them. More training in palliative care for all clinicians is urgently needed. COVID-19 exposed much that is wrong or weak or inadequate in our healthcare systems, but it also allowed us to embrace new technologies and develop better systems to manage the challenge of a pandemic.
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Hong SM, Park YW, Choi EJ. Steroid injections in pain management: influence on coronavirus disease 2019 vaccines. Korean J Pain 2022; 35:14-21. [PMID: 34966008 PMCID: PMC8728555 DOI: 10.3344/kjp.2022.35.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 12/21/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, which has been rampant since the end of 2019, has evidently affected pain management in clinical practice. Fortunately, a COVID-19 vaccination program is currently in progress worldwide. There is an ongoing discussion that pain management using steroid injections can decrease COVID-19 vaccine efficacy, although currently there is no direct evidence to support this statement. As such, the feeling of pain in patients is doubled in addition to the co-existing ill-effects of social isolation associated with the pandemic. Thus, in the COVID-19 era, it has become necessary that physicians be able to provide high quality pain management without negatively impacting COVID-19 vaccine efficacy. Steroids can alter the entire process involved in the generation of adaptive immunity after vaccination. The period of hypophysis-pituitary-adrenal axis suppression is known to be 1 to 4 weeks after steroid injection, and although the exact timing for peak efficacy of COVID-19 vaccines is slightly different for each vaccine, the average is approximately 2 weeks. It is suggested to avoid steroid injections for a total of 4 weeks (1 week before and after the two vaccine doses) for the double-shot vaccines, and for 2 weeks in total (1 week before and after vaccination) for a single-shot vaccine. This review focuses on the basic concepts of the various COVID-19 vaccines, the effect of steroid injections on vaccine efficacy, and suggestions regarding an appropriate interval between the administration of steroid injections and the COVID-19 vaccine.
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Affiliation(s)
- Sung Man Hong
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeon Wook Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Corrias A, Cortes GM, Bardanzellu F, Melis A, Fanos V, Marcialis MA. Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8090753. [PMID: 34572185 PMCID: PMC8468140 DOI: 10.3390/children8090753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022]
Abstract
Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.
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Serrano Afonso AA, Pérez Hernández C, Ochoa Mazarro D, Román Martínez M, Failde Martínez I, Montes Pérez A, López Pais P, Cánovas Martínez L, Revuelta Rizo M, Padilla del Rey ML, Peiró Perió A, Aberasturi Fueyo T, Margarit Ferrí C, Rojo Rodríguez E, Mendiola de la Osa A, Muñoz Martinez MJ, Domínguez Bronchal MJ, Herrero Trujillano M, Cid Calzada J, Fabregat-Cid G, Hernández-Cádiz MJ, Mareque Ortega M, Gómez-Caro Álvarez Palencia L, Mayoral Rojals V. Association between chronic pain medications and the severity and mortality of COVID-19: Study protocol for a case-population study. Medicine (Baltimore) 2021; 100:e26725. [PMID: 34397708 PMCID: PMC8322492 DOI: 10.1097/md.0000000000026725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
In patients with coronavirus disease 2019 (COVID-19) infection, common drugs may exacerbate symptoms and negatively impact outcomes. However, the role of chronic medications on COVID-19 effects remains poorly understood. We hypothesized that certain chronic pain medications would influence outcomes in patients with COVID-19. The main aim is to assess the effect of these medications on the course of the disease in COVID-19 patients. Secondary aims are to compare disease severity and outcomes in patients with COVID-19 receiving chronic treatment with analgesics or other medications versus untreated patients and to determine prevalence of chronic pain medications in specific subgroups of hospitalized patients for COVID-19. Multicenter case-population study in 15 care centers for patients ≥18 years of age diagnosed and hospitalized with COVID-19. Controls will include patients treated at participating centers for chronic pain during the six-month period prior to March 15th, 2020. Each case will be age- and sex-matched to 10 controls. Patients will be grouped according to disease severity criteria. The primary outcome measures in patients admitted for COVID-19 will be: 1. statistical association between chronic pain medication and disease severity; 2. association between chronic pain treatment and survival. Secondary outcome measures include: 1. prevalence of chronic pain medications in patients with COVID-19 by age and sex; 2. prevalence of chronic pain medications in patients with COVID-19 vs controls. Patients and controls will be paired by age, sex, and geographic residence. Odds ratios with 95% confidence intervals will be calculated to determine the association between each drug and clinical status. Univariate and multivariate analyses will be performed. This is a study protocol. Data is actually being gathered and results are yet not achieved. There is no numerical data presented, so the conclusions cannot be considered solid at this point. Pain medications are likely to influence severity of COVID-19 and patient survival. Identifying those medications that are most closely associated with severe COVID-19 will provide clinicians with valuable data to guide treatment and reduce mortality rates and the long-term sequelae of the disease.
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Affiliation(s)
- Andrés Ancor Serrano Afonso
- Pain Unit, Anthesthesiology Department, Hospital Universitari de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Dolores Ochoa Mazarro
- Department of Clinical Pharmacology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Manuel Román Martínez
- Department of Clinical Pharmacology, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Pablo López Pais
- Pain Unit, Anthesthesiology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Luz Cánovas Martínez
- Pain Unit, Anthesthesiology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Miren Revuelta Rizo
- Pain Unit, Anthesthesiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Luz Padilla del Rey
- Pain Unit, Anthesthesiology Department, Complejo Hospitalario Universitario de Cartagena, Murcia Spain
| | - Ana Peiró Perió
- Pain Unit, Anthesthesiology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - César Margarit Ferrí
- Pain Unit, Anthesthesiology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Elena Rojo Rodríguez
- Pain Unit, Anthesthesiology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | - José Cid Calzada
- Pain Unit, Anthesthesiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Gustavo Fabregat-Cid
- Pain Unit, Anthesthesiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - María José Hernández-Cádiz
- Pain Unit, Anthesthesiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Manuel Mareque Ortega
- Pain Unit, Anthesthesiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | - Víctor Mayoral Rojals
- Pain Unit, Anthesthesiology Department, Hospital Universitari de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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Huynh L, Chang RG, Chhatre A, Sayeed Y, MacVicar J, McCormick ZL, Duszynski B, Smith C. Reopening Interventional Pain Practices during the Early Phase of the COVID-19 Global Pandemic. PAIN MEDICINE 2021; 22:1496-1502. [PMID: 33624827 PMCID: PMC7928578 DOI: 10.1093/pm/pnab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective Examine how interventional pain physicians navigated the early phase of reopening practices during the coronavirus disease 2019 (COVID-19) pandemic. Methods In June/July 2020, Spine Intervention Society members were queried about practice demographics, perception of COVID-19 prevalence, financial impact, and implementation of new tools and procedures when re-opening practices. Results Of the 2,295 members approached, 195 (8%) completed the survey. A majority (71%) reported using risk stratification tools and changing scheduling patterns. Nearly 70% performed initial assessments via telehealth and 87% for follow-up encounters. More than 80% performed symptom/temperature checks upon in-person clinic/facility entrance, and 63% screened patients via phone. Most (58%) did not test patients for COVID-19 for office visits, while 38% tested only if symptomatic. For epidural injections, intra-articular injections, and radiofrequency neurotomy procedures, 43% reported not testing patients, while 36% tested patients only if symptomatic. Most (70%) required patients to wear a mask upon entering the clinic/facility. For nonprocedure encounters, respondents used surgical masks (85%), gloves (35%), face shields/goggles (24%), N95 respirators (15%), and gowns (6%). Some (66%) discussed unique COVID-19 risks/complications and 26% provided written information. Most did not make changes to steroid dosage (67%) or peri-procedural anticoagulation management (97%). The vast majority (81%) estimated that COVID-19 will have a moderate-severe financial impact on their practice. Conclusions COVID-19 has dramatically affected interventional pain practices with regard to telehealth, in-clinic precautions, screening/testing protocols, and patient counseling. Practice patterns will continue to evolve as we learn more about the disease and improve methods to provide safe and effective care.
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Affiliation(s)
- Lisa Huynh
- Physical Medicine and Rehabilitation Section, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Richard G Chang
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Akhil Chhatre
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation and Neurosurgery, Baltimore, Maryland, USA
| | - Yusef Sayeed
- Uniformed Services University of the Health Sciences, Department of Physical Medicine and Rehabilitation, Department of Family Medicine, Eglin Air Force Base, Florida, USA
| | | | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | | | - Clark Smith
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Abstract
Introduction This study aims to determine whether musculoskeletal corticosteroid injections increase the risk for COVID-19. Method 734 patients who received a corticosteroid injection during the COVID-19 pandemic were followed and their COVID status within 30 days after the injection checked. The results were then compared with an age and sex matched control group. Results No statistically significant difference in the frequency of COVID-19 cases between the two groups was found. Conclusion It appears that the use of musculoskeletal corticosteroid injections during the COVID-19 pandemic does not confer increased risk of contracting the virus.
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Lee H, Punt JA, Patel J, Stojanovic MP, Duszynski B, McCormick ZL. Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of Adenovirus Vector-Based COVID-19 Vaccines? PAIN MEDICINE 2021; 22:1441-1464. [PMID: 33839780 PMCID: PMC8083288 DOI: 10.1093/pm/pnab130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 11/14/2022]
Abstract
Myth: Corticosteroid injection for the treatment of pain is known to decrease the efficacy of the adenovirus vector-based vaccines for COVID-19. Fact: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an adenovirus vector-based COVID-19 vaccine decreases the efficacy of the vaccine. •However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Janssen and AstraZeneca vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than two weeks prior to and no less than two weeks following a COVID-19 adenovirus vector-based vaccine dose, whenever possible. •We emphasize the importance of risk/benefit analysis and shared decision-making in determining the timing of corticosteroid injections for pain indications in relation to receipt of a COVID-19 vaccine given that patient-specific factors will vary.
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Affiliation(s)
- Haewon Lee
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Jennifer A Punt
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Jaymin Patel
- Department of Orthopaedics, Emory University, Atlanta, Georgia
| | - Milan P Stojanovic
- Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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Lee H, Punt JA, Miller DC, Nagpal A, Smith CC, Sayeed Y, Patel J, Stojanovic MP, Popescu A, McCormick ZL. Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines? PAIN MEDICINE (MALDEN, MASS.) 2021; 22:994-1000. [PMID: 33605425 PMCID: PMC7928682 DOI: 10.1093/pm/pnab063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
MYTH Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.
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Affiliation(s)
- Haewon Lee
- University of California, San Diego, Department of Orthopedic Surgery, San Diego, California, USA
| | - Jennifer A Punt
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ameet Nagpal
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Clark C Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA
| | - Yusef Sayeed
- Uniformed Services University of the Health Sciences, Department of Physical Medicine and Rehabilitation, Department of Family Medicine, Eglin AFB, Florida, USA
| | - Jaymin Patel
- Emory University, Department of Orthopedics, Atlanta, Georgia, USA
| | - Milan P Stojanovic
- Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Popescu
- Hospital of University of Pennsylvania, Department of Physical Medicine and Rehabilitation, Philadelphia, Pennsylvania, USA
| | - Zachary L McCormick
- University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, Utah, USA
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Gallagher RM. The Social Forces Healing Patients with Painful Conditions: What Happens After COVID-19? PAIN MEDICINE 2021; 22:239-242. [PMID: 33484145 PMCID: PMC7928671 DOI: 10.1093/pm/pnaa486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Brill S, Hochberg U, Goor-Aryeh I. Neuro-axial steroid injection in pain management and COVID-19 vaccine. Eur J Pain 2021; 25:945-946. [PMID: 33565660 PMCID: PMC8013309 DOI: 10.1002/ejp.1749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Silviu Brill
- Institute for Pain Medicine, Department of Anesthesia and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Hochberg
- Institute for Pain Medicine, Department of Anesthesia and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Goor-Aryeh
- Institute for Pain Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
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