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Ghoraba HH, Matsumiya W, Khojasteh H, Akhavanrezayat A, Karaca I, Or C, Yavari N, Lajevardi S, Hwang J, Yasar C, Do D, Nguyen QD. Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis. Clin Ophthalmol 2022; 16:1697-1706. [PMID: 35673349 PMCID: PMC9167570 DOI: 10.2147/opth.s366370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Hashem H Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hassan Khojasteh
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jaclyn Hwang
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Correspondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, USA, Tel +16507257245, Fax +1 6507368232, Email
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Aksakal E, Simsek Z, Aksu U, Birdal O, Ateş ES, Kalkan K, Gulcu O, Demirelli S, Aksakal E, Tas H. Acute cardiac effects of high dose steroid treatment: A speckle tracking echocardiography study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:351-355. [PMID: 30785648 DOI: 10.1002/jcu.22716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE High-dose steroid therapy (HDST) has frequent side-effects that appear at its cessation and depend on its dose. However, there is a lack of studies about the acute effects of HDST on cardiac function in adult patients. METHODS We included in this study 30 patients who underwent HDST (intravenously at doses ranging from 250 to 1000 mg) and 30 healthy control subjects with similar demographic and clinical characteristics, between September and December 2016. Echocardiographic measurements were made before and during the first 3 hours after the end of treatment, and results were compared between patients and controls. RESULTS There was no difference in baseline biochemical and echocardiographic characteristics between the patient and control groups. While left ventricular global longitudinal strain (LVGLS) and strain rate E were higher after treatment, no significant change was observed in conventional echocardiographic variables. CONCLUSIONS LVGLS, but not conventional echocardiographic variables, showed an increase in cardiac systolic function at the acute phase of HDST.
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Affiliation(s)
- Emrah Aksakal
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ziya Simsek
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Uğur Aksu
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oguzhan Birdal
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Esma Selva Ateş
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Enbiya Aksakal
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Hakan Tas
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Parker BJ, Bruce IN. High dose methylprednisolone therapy for the treatment of severe systemic lupus erythematosus. Lupus 2016; 16:387-93. [PMID: 17664228 DOI: 10.1177/0961203307079502] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pharmacological armamentarium for the treatment of SLE is expanding and a number of novel therapies are currently under investigation. In spite of this, steroid therapy remains the cornerstone of treatment and intravenous methylprednisolone (IVMP) is still widely used in clinical practice. There is however surprisingly little evidence on which to define its precise role. The objective of this review was to consider the published evidence relating to the use of IVMP in SLE patients and also to identify open questions that still need to be answered with regard to its use.In acute flares, IVMP induces rapid suppression of acute inflammation. There is not however a strong evidence base to support the use of high doses compared to low IVMP doses or oral prednisolone. In maintenance regimes, secondary analyses suggest that IVMP may confer additional long-term renal survival over oral steroids as part of a cyclophosphamide regime. Therefore, in addition to the evaluation of novel therapies for SLE, better evidence to define the precise role of IVMP in SLE is still required. ( Lupus (2007) 16, 387—393)
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Affiliation(s)
- B J Parker
- The Kellgren Centre for Rheumatology, Central Manchester and Manchester Children's NHS Trust, Manchester Royal Infirmary
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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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Jain R, Kumar B. Immediate and Delayed Complications of Dexamethasone Cyclophosphamide Pulse (DCP) Therapy. J Dermatol 2014; 30:713-8. [PMID: 14684952 DOI: 10.1111/j.1346-8138.2003.tb00464.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2003] [Accepted: 06/24/2003] [Indexed: 11/29/2022]
Abstract
Dexamethasone-cyclophosphamide pulse (DCP) is the prefered mode of therapy in pemphigus in India because it is relatively free from the side effects seen with heavy doses of daily oral steroids. One hundred forty-six pemphigus patients treated with DCP were observed for side effects of this regimen. One hundred forty mg of dexamethasone was administered IV in 200 ml of 5% dextrose over a period of 60-90 minutes on 3 consecutive days. Five hundred mg of cyclophosphamide was added on first day of the pulse and 50 mg given orally daily in the intervening period. DCP was repeated every 4 weeks and continued for 6 months after subsidence of the disease (no new lesions). Flushing over the face was the most common event recorded during the adiministration in 78 subjects followed by palpitations in 11, hiccups in 9, and numbness of feet in 6. Fourteen patients had polyurea, and 3 developed skin rash. Shivering, shooting pains along thighs, breathlessness, seizure and unilateral limb edema were observed in one patient each. Generalized weakness/malaise was the most troublesome delayed side effect in 81 (55.4%) patients; it lasted for 8-15 days after the pulse. Thirty-six (24.6%) had inadequate sleep syndrome, 23 (15.7%) had headache, 21 (14.3%) complained of arthralgias, 19 (13%) experienced alteration in taste, and 13 (9%) had diffuse hair loss. 28 females developed menstrual disturbances, and 14 (9.5%) had blurring of vision (glaucoma in 3 and posterior subcapsular cataract in 1). Thirteen of eighteen diabetics had an increase in blood sugar requiring higher doses of insulin. Five NIDDM patients needed insulin. Four (2.7%) developed hypertension. Pulse therapy is not absolutely free from side effects. Hypertension and diabetes occur less frequently as compared to conventional steroid therapy. Generalized weakness, flushing, headache and taste alteration occur exclusively with pulse therapy.
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Affiliation(s)
- Rajesh Jain
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Miura M, Tamame T, Naganuma T, Chinen S, Matsuoka M, Ohki H. Steroid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy. Paediatr Child Health 2011; 16:479-84. [PMID: 23024586 PMCID: PMC3202387 DOI: 10.1093/pch/16.8.479] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2010] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal management of Kawasaki disease (KD) unresponsive to intravenous immunoglobulin (IVIG) therapy remains unclear. OBJECTIVE To prospectively evaluate the efficacy and safety of intravenous methylprednisolone pulse (IVMP) therapy in KD cases unresponsive to additional IVIG. METHODS KD patients who initially received IVIG (2 g/kg/24 h) and acetylsalicylic acid within nine days after disease onset were studied. Patients who did not respond received additional IVIG (2 g/kg/24 h), and those who still did not respond were given IVMP (30 mg/kg/day) for three days, followed by oral prednisolone. The response to treatment, echocardiographic findings and adverse effects were evaluated. RESULTS Among 412 KD cases, 74 (18.0%) were treated with additional IVIG; 21 (28.4%) of the latter cases subsequently received IVMP followed by prednisolone. All cases became afebrile soon after IVMP infusion and did not have a high-grade fever during treatment with prednisolone for two to six weeks. Four weeks after disease onset, coronary artery lesions (CAL) were diagnosed according to the Japanese Ministry of Health and Welfare or the American Heart Association criteria in two of the 21 cases treated with IVMP plus prednisolone; among all 412 cases, three (0.7%) and eight (1.9%) had CAL according to each criteria, respectively. All CAL regressed completely one year after disease onset. Adverse effects of IVMP, such as hypothermia and sinus bradycardia, resolved spontaneously. CONCLUSIONS In KD patients unresponsive to additional IVIG, IVMP promptly induced defervescence, and subsequent oral prednisolone suppressed recurrence of fever. IVMP followed by prednisolone therapy may prevent CAL, without severe adverse effects.
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Affiliation(s)
- Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children’s Medical Center (formerly Tokyo Metropolitan Kiyose Children’s Hospital), Fuchu, Tokyo, Japan
| | - Takuya Tamame
- Division of Cardiology, Tokyo Metropolitan Children’s Medical Center (formerly Tokyo Metropolitan Kiyose Children’s Hospital), Fuchu, Tokyo, Japan
| | - Takashi Naganuma
- Division of Cardiology, Tokyo Metropolitan Children’s Medical Center (formerly Tokyo Metropolitan Kiyose Children’s Hospital), Fuchu, Tokyo, Japan
| | - Shino Chinen
- Division of Cardiology, Tokyo Metropolitan Children’s Medical Center (formerly Tokyo Metropolitan Kiyose Children’s Hospital), Fuchu, Tokyo, Japan
| | - Megumi Matsuoka
- Division of Cardiology, Tokyo Metropolitan Children’s Medical Center (formerly Tokyo Metropolitan Kiyose Children’s Hospital), Fuchu, Tokyo, Japan
| | - Hirotaka Ohki
- Division of Cardiology, Tokyo Metropolitan Children’s Medical Center (formerly Tokyo Metropolitan Kiyose Children’s Hospital), Fuchu, Tokyo, Japan
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Effects of methylprednisolone pulse on cytokine levels in Kawasaki disease patients unresponsive to intravenous immunoglobulin. Eur J Pediatr 2008; 167:1119-23. [PMID: 18175148 DOI: 10.1007/s00431-007-0642-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 10/18/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
Abstract
This study aimed to determine the effects of intravenous methylprednisolone pulse (IVMP) therapy on cytokine levels in patients with acute Kawasaki disease (KD) unresponsive to initial intravenous immunoglobulin (IVIG) therapy. Fifteen KD patients unresponsive to initial IVIG, 2 g/kg/day, were randomized to receive IVMP (n = 7), 30 mg/kg/day for 3 days or additional IVIG (n = 8), 2 g/kg/day, and plasma cytokine levels were compared. The fraction of febrile patients was significantly lower in the IVMP group than in the additional IVIG group on day 2 (0/7 vs. 3/8, p = 0.03), but not on day 4 and later (3/7 vs. 4/8, p = 1.00) because of recurrent fever. The prevalence of coronary lesions was similar between the two groups (2/7 vs. 2/8, p = 1.00). The ratios of plasma levels of tumor necrosis factor-alpha and monocyte chemoattractant protein-1 to those at enrollment (defined as day 1) were significantly lower in the IVMP group on day 4 (0.50 +/- 0.27 vs. 1.01 +/- 0.46, 0.53 +/- 0.39 vs. 0.93 +/- 0.44, p = 0.02 and 0.045, respectively), but not on day 7 (0.54 +/- 0.34 vs. 0.88 +/- 0.39, 0.76 +/- 0.39 vs. 0.61 +/- 0.17, p = 0.07 and 0.83, respectively). The ratios of interleukin-2 receptor, interleukin-6, and vascular endothelial cell growth factor to those at enrollment did not differ significantly between the two groups. In conclusion, for KD patients unresponsive to initial IVIG, IVMP suppresses cytokine levels faster, but subsequently similarly, compared with additional IVIG.
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Micó-Llorens JM, Satorres-Nieto M, Gargallo-Albiol J, Arnabat-Domínguez J, Berini-Aytés L, Gay-Escoda C. Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol 2006; 62:693-8. [PMID: 16902792 DOI: 10.1007/s00228-006-0164-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 05/15/2006] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Impacted third molar extraction causes considerable swelling in the days immediately following surgery. The aim of the present investigation was to evaluate the efficacy of methylprednisolone as a single 40-mg intramuscular dose in controlling the complications of impacted lower third molar surgical removal. MATERIALS AND METHODS Thirty-five patients were evaluated within the framework of a consecutive sampling and double-blind study with intrasubject measurements. Extraction comprised ostectomy with tooth sectioning of both lower third molars under local anesthesia. The study group received 40 mg of methylprednisolone injected into the gluteal region, while the controls received no such medication. In each individual one molar was randomly assigned to the study group and the other to the control series - with extraction of the two teeth being spaced 1 month apart. Evaluations were made of postoperative pain, trismus and swelling, and measurements were obtained for oral aperture and various distances (tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye) before surgery and 2-7 days after extraction. Statistical correlations were made based on the Student t-test for the comparison of means of related samples. RESULTS A statistically and clinically significant association was observed 2 days after surgery between methylprednisolone administration and increased oral aperture and diminished facial swelling. Likewise, less pain was recorded in the study group 6 h after surgery. CONCLUSION The results confirm the efficacy of methylprednisolone in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars.
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Affiliation(s)
- J M Micó-Llorens
- Master of Oral Surgery and Implantology, School of Dentistry of University of Barcelona, Barcelona, Spain
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Jain R, Bali H, Sharma VK, Kumar B. Cardiovascular effects of corticosteroid pulse therapy: a prospective controlled study on pemphigus patients. Int J Dermatol 2005; 44:285-8. [PMID: 15811078 DOI: 10.1111/j.1365-4632.2004.02587.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rajesh Jain
- Department of Dermatology, Venereology & Leprology and Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Üstün Y, Erdoǧan Ö, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1079-2104(03)00464-5] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Badsha H, Edwards CJ. Intravenous pulses of methylprednisolone for systemic lupus erythematosus. Semin Arthritis Rheum 2003; 32:370-7. [PMID: 12833245 DOI: 10.1053/sarh.2002.50003] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Intravenous (IV) pulses of methylprednisolone (MEP) commonly are used to treat severe manifestations of systemic lupus erythematosus (SLE). However, despite wide use of this treatment the best dose, timing, and the situations in which this treatment should be used remain largely anecdotal. AIM To review the mechanisms of action and evidence for clinical use of IV MEP in the treatment of SLE. METHOD The literature on MEP use in SLE from 1966 to 2002, using PubMed from the National Library of Medicine, was reviewed. RESULTS As with other modes of corticosteroid administration, IV MEP has significant anti-inflammatory and immunosuppressive actions. These actions have been shown to be effective in treating SLE in clinical trials, for lupus nephritis. The studies are mainly uncontrolled and retrospective. Long-term observations from a few double-blind prospective trials suggest that monthly pulses of MEP, in addition to IV cyclophosphamide, may be useful. Pulse MEP is beneficial for several serious manifestations of SLE, such as neuro-psychiatric lupus, pulmonary hemorrhage, severe blood dyscrasias, cardiomyopathy, and vasculitis. However, significant side effects may occur, mostly infections, which are worse in patients with hypoalbuminemia. CONCLUSION IV pulses of MEP rapidly immunosuppress patients with organ and/or life-threatening manifestations of SLE. However, the gold standard 1 g/day for 3 consecutive days is associated with significant infectious complications and lower doses may be just as useful.
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Affiliation(s)
- Humeira Badsha
- Department of Rheumatology, Tan Tock Seng Hospital, Singapore
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The Use of Steroids and Nonsteroidal Anti-Inflammatory Drugs in Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2001. [DOI: 10.1016/s1042-3699(20)30157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hinz B, Hirschelmann R. Dexamethasone megadoses stabilize rat liver lysosomal membranes by non-genomic and genomic effects. Pharm Res 2000; 17:1489-93. [PMID: 11303958 DOI: 10.1023/a:1007652908104] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Membrane-stabilizing effects may be part of glucocorticoid action during high-dose glucocorticoid therapy. The present study investigates the mode of action of dexamethasone megadoses on rat liver lysosomal membranes. METHODS Following intravenous administration of dexamethasone in rats, the release of beta-glucuronidase from liver lysosomes was assessed ex vivo as a marker for lysosomal membrane integrity. RESULTS Dexamethasone megadoses significantly inhibited beta-glucuronidase release 10 min post-administration by 38% (3 mg/kg dexamethasone) and 33% (10 mg/kg dexamethasone) at corresponding dexamethasone liver concentrations of 3.9 x 10(-5) mol/kg and 15.1 x 10(-5) mol/kg, respectively. Comparable inhibition of beta-glucuronidase release (34% for 3 mg/kg and 38% for 10 mg/kg) was observed 24 h after administration of dexamethasone, although dexamethasone liver concentrations had already declined to 0.09 x 10(-5) mol/kg and 0.19 x 10(-5) mol/kg, respectively. A 2-h oral pretreatment of rats with the glucocorticoid receptor antagonist RU 486 (10 mg/kg) did not alter immediate (10 min) stabilization by dexamethasone (3 mg/kg). but almost completely prevented lysosomal membrane protection 24 h after dexamethasone injection. CONCLUSIONS Dexamethasone megadoses may preserve lysosomal membrane integrity by a dual action involving both rapid nongenomic effects occurring instantaneously after administration and long-term receptor-dependent genomic events.
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Affiliation(s)
- B Hinz
- Department of Experimental and Clinical Pharmacology and Toxicology, Friedrich Alexander University Erlangen-Nürnberg, Germany.
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Abstract
High-dose intravenous (i.v.) methylprednisolone has been used therapeutically in a number of medical fields to avoid the complications and side effects of long-term glucocorticoid (GC) therapy and because of the perception that high-dose i.v. methylprednisolone may have "special" therapeutic effects. It is possible that aggressive early therapy with GCs allows for a more rapid taper of GCs and therefore prevents some of the dose-related side effects associated with long-term use. Some of the neurologic and rheumatologic literature related to multiple sclerosis and lupus nephritis suggest that i.v. methylprednisolone has therapeutic effects that are different from those of conventional doses of oral prednisone. There is still considerable debate about this in nondermatologic fields, and extrapolation of the role of pulse i.v. methylprednisolone to dermatologic disease, where trials are lacking, is difficult. Given this subset of possible candidates of this therapy as suggested by anecdotal reports, there is at least a rationale for considering the use of this modality in a subset of patients.
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Affiliation(s)
- S Sabir
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
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Esen E, Taşar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J Oral Maxillofac Surg 1999; 57:1201-6; discussion 1206-8. [PMID: 10513866 DOI: 10.1016/s0278-2391(99)90486-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The anti-inflammatory effect and adrenal suppressive side effect of methylprednisolone sodium succinate (MP) on the postoperative sequelae of third molar surgery were evaluated using objective methods in a double-blind, crossover study. PATIENTS AND METHODS Twenty patients who were to undergo surgical removal of bilateral, symmetrically placed lower third molars were studied. Each patient was given 125 mg MP intravenously before surgery on one side, and a placebo before surgery on the opposite side on a random basis. Ultrasonographic and computed tomographic examinations were performed to determine the amount of facial edema. Trismus was evaluated by measuring maximal interincisal opening, and pain was evaluated by recording the number of standard analgesic tablets used on the day of surgery and the first postoperative day. Hypothalamic-pituitary-adrenal (HPA) axis function was tested by measuring basal plasma cortisol (hydrocortisone) levels preoperatively and postoperatively. The adrenocorticotropic hormone (ACTH) stimulation test also was performed before and after administration of MP, to evaluate adrenal function. RESULTS Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the MP group. Plasma cortisol levels showed a nonsignificant decrease in both the MP- and placebo-treated groups. The ACTH stimulation test indicated normal HPA axis function before and after MP administration. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. Eighteen patients (90%) indicated a preference for the overall postoperative course when MP was used. CONCLUSION In the absence of contraindications for corticosteroid administration, preoperative use of MP appears to be a safe and effective method of reducing postoperative complications in third molar surgery.
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Affiliation(s)
- E Esen
- Department of Oral Surgery, Faculty of Dentistry, University of Cukurova, Adana, Turkey
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Athreya BH. Management of rheumatic diseases in children. Indian J Pediatr 1996; 63:305-21. [PMID: 10830006 DOI: 10.1007/bf02751523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rheumatic diseases are one of the common groups of chronic diseases of childhood. They are multifactorial in origin and tend to involve multiple organ systems. Consequently management of these diseases requires the expertise of many health and allied health professionals. This review article focuses on the medical management of three of the relatively common diseases: juvenile rheumatoid arthritis (JRA), systemic lupus erythematozus (SLE) and dermatomyositis (DM).
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Affiliation(s)
- B H Athreya
- Thomas Jefferson University, Philadelphia, Pa., USA
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Gilmour CH, Sentipal-Walerius JM, Jones JG, Doyle JM, Brozanski BS, Balsan MJ, Mimouni FB. Pulse dexamethasone does not impair growth and body composition of very low birth weight infants. J Am Coll Nutr 1995; 14:455-62. [PMID: 8522724 DOI: 10.1080/07315724.1995.10718536] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Evaluation of repeated pulses of dexamethasone (PDEX), given to improve cardiopulmonary outcome, on growth of very low birth weight (VLBW, < 1500 g) infants. METHODS In this prospective, double-blind, randomized clinical trial, VLBW infants mechanically ventilated at 1 week of age received intravenous PDEX or saline placebo (P) for 3 days, every 10 days, until no supplemental oxygen or ventilation was required or 36 weeks postmenstrual age (PMA). Weight gain, fluid intake, caloric intake, and serum glucose were monitored throughout the study. Nutritional assessment at 36 weeks PMA consisted of weight, length, head circumference, skinfold thickness measures, body composition by total body electrical conductance, and bone mineral content (BMC) by single beam photon absorptiometry. RESULTS 37 PDEX and 31 P infants survived at least 36 days and completed the protocol. Average daily weight gain, fluid intake and caloric intake were not different between groups. The pattern of weight gain (g/kg/day, mean +/- SD) was different: PDEX infants showed significant growth delay during (3.0 +/- 11.4) and immediately after (7.8 +/- 8.7) each pulse, with subsequent growth acceleration (18.3 +/- 8.2) until the next steroid pulse. In contrast, growth rate of P infants was constant (12.6 +/- 3.7) (p = 0.04). Hyperglycemia requiring insulin therapy occurred only in the PDEX group (10/37). The catch-up growth noted between pulses in the PDEX group was explained only in part by insulin therapy. At 36 weeks PMA, there were no differences between groups in body size, composition, or BMC. CONCLUSION PDEX negatively affected glucose metabolism and growth patterns during and immediately after drug exposure. However, assessment near term gestational age showed similar body composition and size in both groups.
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Affiliation(s)
- C H Gilmour
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, USA
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19
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Pai BS, Srinivas CR, Sabitha L, Shenoi SD, Balachandran CN, Acharya S. Efficacy of dexamethasone pulse therapy in progressive systemic sclerosis. Int J Dermatol 1995; 34:726-8. [PMID: 8537165 DOI: 10.1111/j.1365-4362.1995.tb04664.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Systemic sclerosis is a disease of unknown etiology for which no specific treatment is effective. Pulse therapy with corticosteroids has been tried for various autoimmune disorders with minimal side effects. We undertook this study to determine the efficacy of dexamethasone pulse therapy in progressive systemic sclerosis (PSS). METHODS Five women with PSS between the ages 30 and 60 years, received 100 mg dexamethasone in 500 mL of 5% dextrose by slow intravenous infusion over 3 hours for 3 consecutive days, once a month. RESULTS All patients had symptomatic and clinical improvement. The vital capacity improved in three and posttreatment histopathologic regression was seen in two patients. CONCLUSIONS Dexamethasone pulse therapy may provide an additional option for treating systemic sclerosis.
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Affiliation(s)
- B S Pai
- Department of Dermatology, Kasturba Medical College & Hospital, Manipal, India
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20
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Brozanski BS, Jones JG, Gilmour CH, Balsan MJ, Vazquez RL, Israel BA, Newman B, Mimouni FB, Guthrie RD. Effect of pulse dexamethasone therapy on the incidence and severity of chronic lung disease in the very low birth weight infant. J Pediatr 1995; 126:769-76. [PMID: 7752005 DOI: 10.1016/s0022-3476(95)70410-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We conducted a prospective, randomized, double-blind trial to assess the efficacy and safety of pulse doses of dexamethasone on survival without supplemental oxygen in very low birth weight infants at high risk of having chronic lung disease. Seventy-eight infants with birth weights < or = 1500 gm who were ventilator dependent at 7 days of postnatal age were randomly assigned to receive pulse doses of dexamethasone, 0.5 mg/kg per day, divided twice daily (n = 39), or an equivalent volume of saline solution placebo (n = 39), for 3 days at 10-day intervals until they no longer required supplemental oxygen or assisted ventilation, or reached 36 weeks of postmenstrual age. At study entry, the groups did not differ by birth weight, gestational age, or severity of lung disease. At 36 weeks of postmenstrual age, there was both a significant increase in survival rates without oxygen supplementation (p = 0.03) and a significant decrease in the incidence of chronic lung disease (p = 0.047) in the group that received pulse therapy. Supplemental oxygen requirements were less throughout the study period in the group that received repeated pulse doses of dexamethasone (p = 0.013). The total numbers of deaths and the durations of supplemental oxygen, ventilator support, and hospital stay did not differ between groups. Recorded side effects in the pulse therapy group were minimal and included an increase in the use of insulin therapy for hyperglycemia (p < 0.05). We conclude that in this population of very low birth weight infants, treatment with pulse doses of dexamethasone resulted in improvement in pulmonary outcome without clinically significant side effects.
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Affiliation(s)
- B S Brozanski
- Department of Pediatrics, University of Pittsburgh, Pennsylvania, USA
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21
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Kapisinszky N. Immunological indices of patients with rheumatoid arthritis after methylprednisolone pulse therapy. Ann Rheum Dis 1990; 49:818-9. [PMID: 2241278 PMCID: PMC1004245 DOI: 10.1136/ard.49.10.818-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hirschelmann R, Schade R, Bürger W, Bekemeier H. Nonspecific action of glucocorticosteroids after high-dose pulse therapy? AGENTS AND ACTIONS 1990; 31:148-51. [PMID: 2285020 DOI: 10.1007/bf02003235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The original view of glucocorticoid effects as being divided into physiological and pharmacological ones is no longer acceptable, i.e. all glucocorticoid effects are apparently mediated by receptor occupation which triggers RNA protein synthesis. The concentrations needed for receptor-mediated effects are low, e.g. the KD value for dexamethasone is in the nanomolar range. The high-dose pulse glucocorticoid therapy results in blood concentrations much higher than those necessary for receptor saturation. This makes sense only when nonspecific effects may be expected to occur which necessitate concentrations higher than 10(-6) mol.l-1. In this paper the question of nonspecific glucocorticoid effects in adjuvant arthritis and carrageenin paw edema of rats was investigated using the glucocorticoid receptor antagonist RU 38486 and by injecting the RNA/protein synthesis inhibitors actinomycin D or cycloheximide. We did not find convincing evidence for nonspecific glucocorticoid mechanisms.
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Affiliation(s)
- R Hirschelmann
- Department of Pharmacology, Martin Luther University of Halle-Wittenberg, DDR
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Montgomery MT, Hogg JP, Roberts DL, Redding SW. The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J Oral Maxillofac Surg 1990; 48:179-87. [PMID: 2405122 DOI: 10.1016/s0278-2391(10)80207-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Acceptance of the use of glucocorticosteroids in density to control postsurgical inflammation has been impaired by concerns over side effects, adrenal suppression, and efficacy. The pattern of administration generally used is characterized as short-term, high-dose or pulse therapy, which has not been associated with significant side effects or adrenal suppression beyond 10 days. The selection of an appropriate glucocorticosteroid with minimal mineralocorticoid activity and extended biological activity is desirable. Oral and parenteral dosing are possible, and the latter can be administered as acetates (repository) or esters. The efficacy of glucocorticosteroids in reducing pain, swelling, and trismus after third molar surgery is difficult to ascertain because of methodological inconsistencies between investigations. In general, studies that used low dosing schedules have failed to produce dramatic and prolonged results. High-dosing intravenous (IV) studies have demonstrated significant short-term improvements, but the effects were not sustained. Combining IV administration with multiple oral dosing or a single intramuscular (IM) dose may be required to extend short-term improvement. High-dosing IM studies have shown significant and sustained anti-inflammatory effects with a single dose administered either pre- or post-operatively.
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Affiliation(s)
- M T Montgomery
- Department of General Practice, University of Texas Health Science Center, San Antonio 78284-7914
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Tvede N, Nielsen LP, Andersen V. Bradycardia after high-dose intravenous methylprednisolone therapy. Scand J Rheumatol 1986; 15:302-4. [PMID: 3798047 DOI: 10.3109/03009748609092597] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 5 consecutive patients with rheumatoid arthritis who received intravenous high-dose methylprednisolone (MP) therapy (1 g daily for 2 or 3 consecutive days), a decline in pulse rate was observed, most pronounced on day 4. In one of the 5 patients the bradycardia was associated with complaints of substernal pressure. Reversal to normal heart rate was found on day 7. Electrocardiographic registrations showed sinus bradycardia in all cases. No significant changes in plasma concentrations of electrolytes were found. Careful observation of patients receiving high-dose MP is recommended. High-dose MP may be contraindicated in patients with known heart disease.
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