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Edlmann E, Thelin EP, Caldwell K, Turner C, Whitfield P, Bulters D, Holton P, Suttner N, Owusu-Agyemang K, Al-Tamimi YZ, Gatt D, Thomson S, Anderson IA, Richards O, Gherle M, Toman E, Nandi D, Kane P, Pantaleo B, Davis-Wilkie C, Tarantino S, Barton G, Marcus HJ, Chari A, Belli A, Bond S, Gafoor R, Dawson S, Whitehead L, Brennan P, Wilkinson I, Kolias AG, Hutchinson PJA. Dex-CSDH randomised, placebo-controlled trial of dexamethasone for chronic subdural haematoma: report of the internal pilot phase. Sci Rep 2019; 9:5885. [PMID: 30971773 PMCID: PMC6458174 DOI: 10.1038/s41598-019-42087-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/01/2019] [Indexed: 12/31/2022] Open
Abstract
The Dex-CSDH trial is a randomised, double-blind, placebo-controlled trial of dexamethasone for patients with a symptomatic chronic subdural haematoma. The trial commenced with an internal pilot, whose primary objective was to assess the feasibility of multi-centre recruitment. Primary outcome data collection and safety were also assessed, whilst maintaining blinding. We aimed to recruit 100 patients from United Kingdom Neurosurgical Units within 12 months. Trial participants were randomised to a 2-week course of dexamethasone or placebo in addition to receiving standard care (which could include surgery). The primary outcome measure of the trial is the modified Rankin Scale at 6 months. This pilot recruited ahead of target; 100 patients were recruited within nine months of commencement. 47% of screened patients consented to recruitment. The primary outcome measure was collected in 98% of patients. No safety concerns were raised by the independent data monitoring and ethics committee and only five patients were withdrawn from drug treatment. Pilot trial data can inform on the design and resource provision for substantive trials. This internal pilot was successful in determining recruitment feasibility. Excellent follow-up rates were achieved and exploratory outcome measures were added to increase the scientific value of the trial.
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Affiliation(s)
- Ellie Edlmann
- Department of Clinical Neuroscience, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. .,Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - Eric P Thelin
- Department of Clinical Neuroscience, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Karen Caldwell
- Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Carole Turner
- Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Peter Whitfield
- Southwest Neurosurgical Centre, Plymouth University Hospitals NHS trust, Plymouth, PL6 8DH, UK
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, Hampshire, SO16 6YD, UK
| | - Patrick Holton
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, Hampshire, SO16 6YD, UK
| | - Nigel Suttner
- Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Kevin Owusu-Agyemang
- Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Yahia Z Al-Tamimi
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Daniel Gatt
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Simon Thomson
- Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Ian A Anderson
- Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Oliver Richards
- Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Monica Gherle
- Southwest Neurosurgical Centre, Plymouth University Hospitals NHS trust, Plymouth, PL6 8DH, UK
| | - Emma Toman
- Department of Neurosurgery, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2WB, UK
| | - Dipankar Nandi
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Phillip Kane
- Department of Neurosurgery, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Beatrice Pantaleo
- Cambridge Clinical Trials Unit, Box 401, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Carol Davis-Wilkie
- Cambridge Clinical Trials Unit, Box 401, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Silvia Tarantino
- Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Hani J Marcus
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Aswin Chari
- Department of Neurosurgery, Barts Health NHS trust, Whitechapel Road, London, E1 1BB, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre & University Hospitals Birmingham NHS Foundation Trust, School of Clinical and Experimental Medicine, University of Birmingham, Institute of Biomedical Research (West), Room WX 2.61, Edgbaston, Birmingham, B15 2TT, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Box 401, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,MRC Biostatistics Unit, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Rafael Gafoor
- Cambridge Clinical Trials Unit, Box 401, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Sarah Dawson
- Cambridge Clinical Trials Unit, Box 401, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,MRC Biostatistics Unit, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Lynne Whitehead
- Clinical Trials Pharmacy, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Paul Brennan
- Department of Clinical Neurosciences, Western General Hospitals NHS Trust, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Ian Wilkinson
- Cambridge Clinical Trials Unit, Box 401, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Angelos G Kolias
- Department of Clinical Neuroscience, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Peter J A Hutchinson
- Department of Clinical Neuroscience, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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Sun WP, Yuan GX, Hu YJ, Liao LZ, Fu L. Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease. World J Emerg Med 2015; 6:34-9. [PMID: 25802564 DOI: 10.5847/wjem.j.1920-8642.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 01/17/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insufficiency (CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit (ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group (n=32) and a control group (n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone (150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers of inflammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically significant. RESULTS Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI (23.8% vs. 8.7%, P<0.01). Kaplan-Meier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group (P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group (18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers of infection and inflammation (P<0.01), such as C-reactive protein (13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α (26.1±16.2 μg/L vs. 17.5±11.7 μg/L for the control group; 25.0±14.8 μg/L vs. 10.4±7.8 μg/L for the treatment group) and procalcitonin (3.88 μg/L vs. 2.03 μg/L for the control group; 3.77 μg/L vs. 1.26 μg/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group (P<0.01). CONCLUSION The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers of infection and inflammation.
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Affiliation(s)
- Wei-Ping Sun
- Department of Geriatrics, the First People's Hospital of Xiangtan City, Xiangtan 411101, China
| | - Guang-Xiong Yuan
- Department of Critical Medicine, Xiangtan Municipal Central Hospital, Xiangtan 411100, China
| | - Yan-Juan Hu
- Department of Emergency Medicine, the First People's Hospital of Xiangtan City, Xiangtan 411101, China
| | - Li-Zhen Liao
- Department of Geriatrics, the First People's Hospital of Xiangtan City, Xiangtan 411101, China
| | - Lin Fu
- Department of Critical Medicine, Xiangtan Municipal Central Hospital, Xiangtan 411100, China
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Zorgati H, Prieur F, Vergniaud T, Cottin F, Do MC, Labsy Z, Amarantini D, Gagey O, Lasne F, Collomp K. Ergogenic and metabolic effects of oral glucocorticoid intake during repeated bouts of high-intensity exercise. Steroids 2014; 86:10-5. [PMID: 24793567 DOI: 10.1016/j.steroids.2014.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/04/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
All systemically administered glucocorticoids (GC) are prohibited in-competition, because of the potential ergogenic effects. Although short-term GC intake has been shown to improve performance during submaximal exercise, literature on its impact during brief intense exercise appears to be very scant. The purpose of this study was to examine the ergogenic and metabolic effects of prednisone during repeated bouts of high-intensity exercise. In a double-blind randomized protocol, ten recreational male athletes followed two 1-week treatments (Cor: prednisone, 60mg/day or Pla: placebo). At the end of each treatment, they hopped on their dominant leg for 30s three times consecutively and then hopped until exhaustion, with intervals of 5min of passive recovery. Blood and saliva samples were collected at rest and 3min after each exercise bout to determine the lactate, interleukin-6, interleukin-10, TNF-alpha, DHEA and testosterone values. The absolute peak force of the dominant leg was significantly increased by Cor but only during the first 30-s hopping bout (p<0.05), whereas time to exhaustion was not significantly changed after Cor treatment vs Pla (Pla: 119.9±24.7; Cor: 123.1±29.5s). Cor intake lowered basal and end-exercise plasma interleukin-6 and saliva DHEA (p<0.01) and increased interleukin-10 (p<0.01), whereas no significant change was found in blood lactate and TNF-alpha or saliva testosterone between Pla and Cor. According to these data, short-term glucocorticoid intake did not improve endurance performance during repeated bouts of high-intensity exercise, despite the significant initial increase in absolute peak force and anti-inflammatory effect.
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Affiliation(s)
- Houssem Zorgati
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Fabrice Prieur
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Thomas Vergniaud
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - François Cottin
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Manh-Cuong Do
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Zakaria Labsy
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | | | - Olivier Gagey
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | | | - Katia Collomp
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France; Département des Analyses, AFLD, France.
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