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Kanduri SR, Velez JCQ. Is Rechallenge Appropriate in Patients that Develop Immune Checkpoint Inhibitor-Associated AKI?: CON. KIDNEY360 2021; 3:803-805. [PMID: 36128485 PMCID: PMC9438430 DOI: 10.34067/kid.0003902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023]
Abstract
This is an Early Access article. Please select the PDF button, above, to view it.
Be sure to also read the PRO: 10.34067/KID.0003962021 and the COMMENTARY 10.34067/KID.0005592021
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Affiliation(s)
| | - Juan Carlos Q. Velez
- Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana,Department of Nephrology, Ochsner Clinical School, Brisbane, Australia
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Yao TC, Wang JY, Chang SM, Chang YC, Tsai YF, Wu AC, Huang JL, Tsai HJ. Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children. JAMA Pediatr 2021; 175:723-729. [PMID: 33871562 PMCID: PMC8056312 DOI: 10.1001/jamapediatrics.2021.0433] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The adverse effects from the long-term use of oral corticosteroids are known, but, to our knowledge, few studies have reported the risk of corticosteroid bursts, particularly among children. OBJECTIVE To quantify the associations of corticosteroid bursts with severe adverse events, including gastrointestinal (GI) bleeding, sepsis, pneumonia, and glaucoma, in children. DESIGN, SETTING, AND PARTICIPANTS This study used data derived from the National Health Insurance Research Database in Taiwan from January 1, 2013, to December 31, 2017, on children younger than 18 years of age and used a self-controlled case series design. Data were analyzed from January 1 to July 30, 2020. EXPOSURE Oral corticosteroid bursts (defined as oral corticosteroid use for ≤14 days). MAIN OUTCOMES AND MEASURES Incidence rates were calculated of 4 severe adverse events (GI bleeding, sepsis, pneumonia, and glaucoma) in children who did or did not receive corticosteroid bursts. Conditional fixed-effect Poisson regression was used to estimate incidence rate ratios (IRRs) of severe adverse events within 5 to 30 days and 31 to 90 days after initiation of corticosteroid bursts. RESULTS Among 4 542 623 children, 23% (1 064 587; 544 268 boys [51.1%]; mean [SD] age, 9.7 [5.8] years) were prescribed a single corticosteroid burst. The most common indications were acute respiratory tract infections and allergic diseases. The incidence rate differences per 1000 person-years between children administered a single corticosteroid burst and those not prescribed corticosteroids were 0.60 (95% CI, 0.55-0.64) for GI bleeding, 0.03 (95% CI, 0.02-0.05) for sepsis, 9.35 (95% CI, 9.19-9.51) for pneumonia, and 0.01 (95% CI, 0.01-0.03) for glaucoma. The IRRs within 5 to 30 days after initiating corticosteroid bursts were 1.41 (95% CI, 1.27-1.57) for GI bleeding, 2.02 (95% CI, 1.55-2.64) for sepsis, 2.19 (95% CI, 2.13-2.25) for pneumonia, and 0.98 (95% CI, 0.85-1.13) for glaucoma; the IRRs within the subsequent 31 to 90 days were 1.10 (95% CI, 1.02-1.19) for GI bleeding, 1.08 (95% CI, 0.88-1.32) for sepsis, 1.09 (95% CI, 1.07-1.11) for pneumonia, and 0.95 (95% CI, 0.85-1.06) for glaucoma. CONCLUSIONS AND RELEVANCE This study suggests that corticosteroid bursts, which are commonly prescribed for children with respiratory and allergic conditions, are associated with a 1.4- to 2.2-fold increased risk of GI bleeding, sepsis, and pneumonia within the first month after initiation of corticosteroid therapy that is attenuated during the subsequent 31 to 90 days.
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Affiliation(s)
- Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jiu-Yao Wang
- Center for Allergy and Clinical Immunology Research, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Chen Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Yi-Fen Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ann Chen Wu
- Precision Medicine and Translational Research Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts,Department of Pediatrics, Children’s Hospital, Boston, Massachusetts
| | - Jing-Long Huang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan,Department of Pediatrics, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital, New Taipei, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
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Schneeweiss MC, Kim SC, Wyss R, Jin Y, Chin K, Merola JF, Mostaghimi A, Silverberg JI, Schneeweiss S. Incidence of Venous Thromboembolism in Patients With Dermatologist-Diagnosed Chronic Inflammatory Skin Diseases. JAMA Dermatol 2021; 157:805-816. [PMID: 34037662 PMCID: PMC8156173 DOI: 10.1001/jamadermatol.2021.1570] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Several studies have linked chronic inflammatory skin diseases (CISDs) with venous thromboembolism (VTE) in a range of data sources with mixed conclusions. Objective To examine the incidence of VTE in patients with vs without CISD. Design, Setting, and Participants A cohort study using commercial insurance claims data from a nationwide US health care database from January 1, 2004, through 2019 was conducted. A total of 158 123 patients with dermatologist-recorded psoriasis, atopic dermatitis, alopecia areata, vitiligo, or hidradenitis suppurativa were included. Risk-set sampling identified patients without a CISD. Patient follow-up lasted until the first of the following occurred: VTE, death, disenrollment, or end of data stream. Exposures Patients with vs without CISD. Main Outcomes and Measures Venous thromboembolism events were identified with validated algorithms. Incidence rates were computed before and after 1:1 propensity-score matching to account for VTE risk factors. Hazard ratios were estimated to compare the incidence of VTE in the CISD vs non-CISD cohorts. Results A total of 158 123 patients were identified with CISD: with psoriasis (n = 96 138), atopic dermatitis (n = 30 418), alopecia areata (n = 17 889), vitiligo (n = 7735), or HS (n = 5934); 9 patients had 2 of these conditions. A total of 1 570 387 patients were without a CISD. The median follow-up time was 1.9 years (interquartile range, 0.8-4.0 years) in patients with CISD. The incidence rate (per 1000 person-years) of outpatient or inpatient VTE was 1.57 in psoriasis, 1.83 in atopic dermatitis, 0.94 in alopecia areata, 0.93 in vitiligo, 1.65 in HS and 1.53 in CISD overall, compared with 1.76 in patients without a CISD. Incidence rates increased in patients aged 50 years or older (2.3 per 1000 person-years) and decreased in those aged 18 to 49 years (0.8 per 1000 person-years). After propensity-score matching to patients without a CISD, the hazard ratio (HR) of VTE was 0.86 (95% CI, 0.75-0.99) in psoriasis, 1.19 (95% CI, 0.95-1.48) in atopic dermatitis, 0.97 (95% CI, 0.65-1.46) in alopecia areata, 0.90 (95% CI, 0.49-1.65) in vitiligo, 1.64 (95% CI, 0.82-3.27) in hidradenitis suppurativa, and 0.94 (95% CI, 0.84-1.05) in CISD overall. Conclusions and Relevance In this large-scale cohort study, CISDs were not associated with an increased incidence of VTE after controlling for relevant VTE risk factors in a representative dermatology patient population.
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Affiliation(s)
- Maria C Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Wyss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kristyn Chin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph F Merola
- Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Associate Editor, JAMA Dermatology
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Sivapalan P, Rutishauser J, Ulrik CS, Leuppi JD, Pedersen L, Mueller B, Eklöf J, Biering-Sørensen T, Gottlieb V, Armbruster K, Janner J, Moberg M, Lapperre TS, Nielsen TL, Browatzki A, Mathioudakis A, Vestbo J, Schüetz P, Jensen JU. Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials. Respir Res 2021; 22:155. [PMID: 34020641 PMCID: PMC8138920 DOI: 10.1186/s12931-021-01745-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Systemic corticosteroid administration for severe acute exacerbations of COPD (AECOPD) reduces the duration of hospital stays. Corticosteroid-sparing regimens have showed non-inferiority to higher accumulated dose regimens regarding re-exacerbation risk in patients with AECOPD. However, it remains unclear whether 14-day or 2–5-day regimens would result in shorter admission durations and changes in mortality risk. We explored this by analysing the number of days alive and out of hospital based on two randomised controlled trials with different corticosteroid regimens. Methods We pooled individual patient data from the two available multicentre randomised trials on corticosteroid-sparing regimens for AECOPD: the REDUCE (n = 314) and CORTICO-COP (n = 318) trials. In the 14-day regimen group, patients were older, fewer patients received pre-treatment with antibiotics and more patients received pre-treatment with systemic corticosteroids. Patients randomly allocated to the 14-day and 2–5-day regimens were compared, with adjustment for baseline differences. Results The number of days alive and out of hospital within 14 days from recruitment was higher for the 2–5 day regimen group (mean 8.4 days; 95% confidence interval [CI] 8.0–8.8) than the 14-day regimen patient group (4.2 days; 95% CI3.4–4.9; p < 0.001). The 14-day AECOPD group had longer hospital stays (mean difference, 5.4 days [standard error ± 0.6]; p < 0.0001) and decreased likelihood of discharge within 30 days (hazard ratio [HR] 0.5; 95% CI 0.4–0.6; p < 0.0001). Comparing the 14-day regimen and the 2–5 day regimen group showed no differences in the composite endpoint ‘death or ICU admission’ (odds ratio [OR] 1.4; 95% CI 0.8–2.3; p = 0.15), new or aggravated hypertension (OR 1.5; 95% CI 0.9–2.7; p = 0.15), or mortality risk (HR 0.8; 95% CI 0.4–1.5; p = 0.45) during the 6-month follow-up period. Conclusion 14-day corticosteroid regimens were associated with longer hospital stays and fewer days alive and out of hospital within 14 days, with no apparent 6-month benefit regarding death or admission to ICU in COPD patients. Our results favour 2–5 day regimens for treating COPD exacerbations. However, prospective studies are needed to validate these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01745-5.
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Affiliation(s)
- Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. .,Department of Internal Medicine, Zealand University Hospital, University of Copenhagen, 4000, Roskilde, Denmark.
| | - Jonas Rutishauser
- Department of Medicine, Clinical Trial Unit, Kantonsspital Baden, 4054, Baden, Switzerland.,Faculty of Medicine, University of Basel, 4001, Basel, Switzerland
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Jörg D Leuppi
- Faculty of Medicine, University of Basel, 4001, Basel, Switzerland.,University Clinic of Medicine, Kantonsspital Baselland, 4410, Liestal, Switzerland
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Beat Mueller
- University Clinic of Medicine, Kantonsspital Baselland, 4410, Liestal, Switzerland.,Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Gottlieb
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Karin Armbruster
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Mia Moberg
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Therese S Lapperre
- Department of Respiratory Medicine, Antwerp University Hospital, and Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Thyge L Nielsen
- Department of Respiratory and Infectious Diseases, Frederiksund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory and Infectious Diseases, Frederiksund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Mathioudakis
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Philipp Schüetz
- Faculty of Medicine, University of Basel, 4001, Basel, Switzerland.,Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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George J, Ganoff M, Lipari M. Corticosteroid Exposure in the Treatment of Severe COPD Exacerbations. J Pharm Pract 2020; 35:101-105. [PMID: 32969325 DOI: 10.1177/0897190020961226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent literature and guidelines support treatment of severe acute exacerbation of COPD (AECOPD) with prednisone 40 mg (or equivalent) for 5 days. OBJECTIVE The purpose of this study was to determine whether systemic corticosteroids were being prescribed at the appropriate dose and duration in the treatment of severe AECOPD at a large academic medical institution. METHODS This was a single-center, retrospective, observational study conducted to evaluate corticosteroid prescribing patterns for adults admitted for severe AECOPD from March to May 2019 at a large academic medical institution. Appropriate therapy was defined as: prednisone 40 mg (or equivalent) for 5 days. The primary outcome was to determine the frequency of appropriate dose and duration. The secondary outcomes were to identify the frequency of appropriate dose or duration, compare the prevalence of adverse effects, such as new/worsening hyperglycemia or hypertension, and compare 30- and 90-day readmission rates. RESULTS Of the 190 patients included, 16 (8.4%) had an appropriate duration and 8 (4.2%) an appropriate dose. Only 4 patients (2.1%) had both appropriate corticosteroid dose and duration. New/worsening hyperglycemia occurred in 96 (50.5%), and hypertension developed in 13 (6.8%). Thirty-day readmission occurred in 46 (24.2%) and 90-day readmission in 78 (41.1%). These were more likely in those without appropriate dose and duration. CONCLUSION Systemic corticosteroids for the treatment of severe AECOPD are not prescribed in accordance with evidence-based recommendations at this institution. This might result in a greater incidence of adverse effects and readmissions.
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Affiliation(s)
- Jamie George
- Department of Pharmacy, Ascension St. John Hospital, Detroit, MI, USA
| | - Michelle Ganoff
- Department of Pharmacy, Ascension St. John Hospital, Detroit, MI, USA
| | - Melissa Lipari
- Department of Pharmacy, Ascension St. John Hospital, Detroit, MI, USA.,Department of Pharmacy Practice, Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI USA
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Yao TC, Huang YW, Chang SM, Tsai SY, Wu AC, Tsai HJ. Association Between Oral Corticosteroid Bursts and Severe Adverse Events : A Nationwide Population-Based Cohort Study. Ann Intern Med 2020; 173:325-330. [PMID: 32628532 DOI: 10.7326/m20-0432] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Long-term use of oral corticosteroids has known adverse effects, but the risk from brief oral steroid bursts (≤14 days) is largely unknown. OBJECTIVE To examine the associations between steroid bursts and severe adverse events, specifically gastrointestinal (GI) bleeding, sepsis, and heart failure. DESIGN Self-controlled case series. SETTING Entire National Health Insurance Research Database of medical claims records in Taiwan. PARTICIPANTS Adults aged 20 to 64 years with continuous enrollment in the National Health Insurance program from 1 January 2013 to 31 December 2015. MEASUREMENTS Incidence rates of severe adverse events in steroid burst users and non-steroid users, as well as incidence rate ratios (IRRs) for severe adverse events within 5 to 30 and 31 to 90 days after initiation of steroid therapy. RESULTS Of 15 859 129 adult participants, 2 623 327 who received a single steroid burst were included. The most common indications were skin disorders and respiratory tract infections. The incidence rates per 1000 person-years in steroid bursts were 27.1 (95% CI, 26.7 to 27.5) for GI bleeding, 1.5 (CI, 1.4 to 1.6) for sepsis, and 1.3 (CI, 1.2 to 1.4) for heart failure. Rates of GI bleeding (IRR, 1.80 [CI, 1.75 to 1.84]), sepsis (IRR, 1.99 [CI, 1.70 to 2.32]), and heart failure (IRR, 2.37 [CI, 2.13 to 2.63]) significantly increased within 5 to 30 days after steroid therapy initiation and attenuated during the subsequent 31 to 90 days. LIMITATION Persons younger than 20 years or older than 64 years were not included. CONCLUSION Oral corticosteroid bursts are frequently prescribed in the general adult population in Taiwan. The highest rates of GI bleeding, sepsis, and heart failure occurred within the first month after initiation of steroid therapy. PRIMARY FUNDING SOURCE National Health Research Institutes, Ministry of Science and Technology of Taiwan, Chang Gung Medical Foundation, and Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- Tsung-Chieh Yao
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (T.Y.)
| | - Ya-Wen Huang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (Y.H., S.T., H.T.)
| | | | - Shun-Yu Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (Y.H., S.T., H.T.)
| | - Ann Chen Wu
- Harvard Pilgrim Health Care Institute, Harvard Medical School, and Boston Children's Hospital, Boston, Massachusetts (A.C.W.)
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (Y.H., S.T., H.T.)
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Eijgelsheim M, Sprangers B. Kidney Biopsy Should Be Performed to Document the Cause of Immune Checkpoint Inhibitor-Associated Acute Kidney Injury: PRO. KIDNEY360 2020; 1:158-161. [PMID: 35368633 DOI: 10.34067/kid.0001192019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Mark Eijgelsheim
- Department of Nephrology, Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute, Catholic University of Leuven, Leuven, Belgium; and.,Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
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Yang W, Li X, Zhong J, Mei X, Liu H, Yang L, Lu L, Hu H. Intratympanic versus intravenous corticosteroid treatment for sudden sensorineural hearing loss in diabetic patients: proposed study protocol for a prospective, randomized superiority trial. Trials 2020; 21:135. [PMID: 32014060 PMCID: PMC6998247 DOI: 10.1186/s13063-020-4077-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/15/2020] [Indexed: 11/16/2022] Open
Abstract
Background Diabetes mellitus is associated with risk of sudden sensorineural hearing loss (SSNHL). Systemic and intratympanic corticosteroids are the two primary treatments for SSNHL in patients with diabetes mellitus. The benefit of intratympanic compared to systemic treatment is the reduced systemic steroid exposure and associated systemic adverse effects. Intratympanic corticosteroid administration may have potential benefits over standard systemic therapies. Methods/design The proposed study is a prospective, randomized superiority trial. A total of 96 patients (48 in each group) will be randomized into the experimental or control group. Patients in the experimental group will receive four 1-mL doses of 40 mg/mL of methylprednisolone over a 1-week period, with a dose administered every 2 days via tympanic membrane injection into the middle ear. The control group will be administered intravenous methylprednisolone (1 mg/kg/day, maximal dose 60 mg/day) for 5 days. The primary outcome for this study is the change in hearing threshold from the first audiogram to the 30-day follow-up audiogram. Secondary outcome measures will include pure-tone average (PTA) at 90-day follow up, visual analog tinnitus scale, visual analog vertigo scale, visual analog aural fullness scale, fasting blood glucose and 2-h postprandial blood glucose during treatment, and the change in glycosylated hemoglobin (HbA1C) levels. Vital signs and otological physical examination will be performed at each follow-up visit. Discussion The efficacy and safety of intratympanic methylprednisolone compared to intravenous methylprednisolone will be investigated in patients with diabetes mellitus and SSNHL. This trial may provide strong evidence for the efficacy and safety of intratympanic corticosteroid treatment and important clinical information for the treatment of patients with diabetes mellitus and SSNHL. Trial registration ChiCTR, ChiCTR1800015954. Registered on 2 May 2018, Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=25326.
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Affiliation(s)
- Weiqiang Yang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, China.,Hearing and Balance Function Medical Engineering Laboratory, Shenzhen, China
| | - Xiaoling Li
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jiatao Zhong
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, China.,Hearing and Balance Function Medical Engineering Laboratory, Shenzhen, China
| | - Xueshuang Mei
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, China.,Hearing and Balance Function Medical Engineering Laboratory, Shenzhen, China
| | - Hongyu Liu
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, China.,Hearing and Balance Function Medical Engineering Laboratory, Shenzhen, China
| | - Le Yang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Liming Lu
- Clinical Research and Data Centre, South China Research Centre for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Hongyi Hu
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, China. .,Hearing and Balance Function Medical Engineering Laboratory, Shenzhen, China.
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