1
|
Merino-Bohórquez V, Berisa-Prado S, Delgado-Valverde M, Tirado-Pérez MJ, García-Palomo M, Alonso-Herreros JM, Cañete-Ramírez C, Dávila-Pousa MD. Physicochemical and microbiological stability study of two new preservative-free methylprednisolone eye drops. Farm Hosp 2024:S1130-6343(24)00015-1. [PMID: 38570209 DOI: 10.1016/j.farma.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/12/2023] [Accepted: 01/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 mg/ml and 10 mg/ml eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome. METHOD The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5 ±3 °C), at room temperature (25 ± 2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones. RESULTS The eye drops stored at 5 °C were the most stable; in the 1 mg/ml eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/ml eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/ml, presented a white precipitate from day 14 and 28 respectively. Non-refrigerated 1 mg/ml eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers. CONCLUSIONS 1 mg/ml MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/ml eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening.
Collapse
Affiliation(s)
- Vicente Merino-Bohórquez
- Servicio de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, España; Departamento de Farmacología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, España.
| | | | | | | | | | | | | | - María Del Dávila-Pousa
- Servicio de Farmacia, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, España
| |
Collapse
|
2
|
Brance ML, Larroudé MS, Somma LF, Giacoia E, Diehl M, Galich AM, Ramirez Stieben LA, Maher MC, De La Vega M, Ringer A, Brun LR. Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy. Reumatol Clin (Engl Ed) 2023; 19:279-284. [PMID: 37147063 DOI: 10.1016/j.reumae.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 05/07/2023]
Abstract
INTRODUCTION AND AIM T-score bone mineral density (BMD) thresholds may influence guidance for treatment in patients under glucocorticoid (GC) therapy. Different BMD thresholds have been described but there is no international consensus. The aim of this study was to find a threshold to help in treatment decision-making in the population under GC therapy. METHODS A working group representing three scientific societies from Argentina was convened. The first team was formed by specialists with expertise in glucocorticoid-induced osteoporosis (GIO) who voted according to summary of evidence. The second team was constituted by a methodology group who coordinated and supervised each stage. We conducted two systematic reviews to synthesize the evidence. The first included trials of drugs used in GIO to analyze the BMD cut-off used as inclusion criteria. In the second, we analyzed the evidence regarding the densitometric thresholds to discriminate between fractured and non-fractured patients under GC treatment. RESULTS In the first review, 31 articles were included for qualitative synthesis and more than 90% of the trials included patients regardless of their densitometric T-score or range of osteopenia. In the second review, 4 articles were included and more than 80% of the T-scores were in the range -1.6 to -2.0. The summary of findings was analyzed and put to a vote. CONCLUSIONS With more than 80% agreement of the voting expert panel, a T-score≤-1.7 was considered the most appropriate for treatment in postmenopausal women and men over 50 years of age under GC therapy. This study could help in treatment decision-making in patients under GC therapy without fractures but other fracture risk factors should certainly be considered.
Collapse
Affiliation(s)
- María Lorena Brance
- Reumatología y Enfermedades Óseas, Rosario, Argentina; Bone Biology Laboratory, School of Medicine, Rosario National University, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
| | | | | | | | - María Diehl
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - María Cielo Maher
- Instituto de Rehabilitación Psicofísica (IREP), Buenos Aires, Argentina
| | | | - Ariana Ringer
- Reumatología y Enfermedades Óseas, Rosario, Argentina; Hospital Provincial del Centenario, Rosario, Argentina
| | - Lucas R Brun
- Bone Biology Laboratory, School of Medicine, Rosario National University, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| |
Collapse
|
3
|
Pampín-Sánchez R, Martínez-Mugica-Barbosa C, Fonseca-Aizpuru EM, Barbazán-Vázquez FJ, Fernández-González B, Buznego-Súárez L. Outcome of tocilizumab treatment in corticosteroid-resistant thyroid eye disease. Med Clin (Barc) 2023; 160:113-7. [PMID: 36088128 DOI: 10.1016/j.medcli.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Thyroid eye disease (TED) is a complex and incompletely understood rare autoimmune disorder. OBJECTIVES To analyze the experience and the outcomes obtained with the use of intravenous tocilizumab in the treatment of TED. METHODS A retrospective analysis of adult patients diagnosed with active TED resistant to intravenous corticosteroids treated in a tertiary hospital between May 2012 and May 2021. RESULTS Eleven patients were included with a mean age of 52±12 (range 35-67) years. Nine patients were female and two were male. Patients received a median of 5±3.2 doses. Twenty out of twenty-four eyes achieved inactivation of TED at week 16. Proptosis response was achieved in 6/8 patients and diplopia response in 3/8 patients. The GO-QOL questionnaire showed clinically significant improvement in 9/11 patients. No serious adverse effects were reported during tocilizumab treatment. One patient required decompressive surgery 15 months after tocilizumab therapy. CONCLUSION The results obtained show that the use of tocilizumab in the treatment of this pathology can be a good alternative.
Collapse
|
4
|
Montero-Pastor N, Sánchez-Costa JT, Guerra-Rodríguez M, Sánchez-Alonso F, Moriano C, Loricera J, Díaz-González F. Development of a web tool to calculate the cumulative dose of glucocorticoids. Reumatol Clin (Engl Ed) 2023; 19:1-5. [PMID: 36603961 DOI: 10.1016/j.reumae.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/01/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Glucocorticoids are associated with serious side effects related to dosing and time of use. Unfortunately, there is no standard method for determining glucocorticoid exposure, especially in patients undergoing long-term treatment. OBJECTIVE The aim of this work was to create a free and easy-to-use web application to calculate, in a systematic way, the total cumulative dose of corticosteroids. METHODS The total cumulative dose is calculated as the sum of all periods of treatment with different doses of corticosteroids, and is expressed as the equivalent dose of prednisone in mg. Glucocorticoid doses during periods in which the available information is missing or incomplete are estimated by systematic assumptions. RESULTS A simulation exercise using standard patterns of steroid use in polymyalgia rheumatica, and giant cell arteritis showed that even when the period of no information reached 50% of the time, the accuracy of the calculator had a mean absolute percentage error (MAPE)<7%. CONCLUSION This tool simplifies and standardizes the glucocorticoids cumulative dose calculation, thereby minimizing bias in the assessment of glucocorticoid cumulative dose.
Collapse
Affiliation(s)
- Nuria Montero-Pastor
- Unidad de Investigación de la Sociedad Española de Reumatología, Calle Marqués de Duero n°5, 28001 Madrid, Spain
| | - Jesús T Sánchez-Costa
- Unidad de Investigación de la Sociedad Española de Reumatología, Calle Marqués de Duero n°5, 28001 Madrid, Spain
| | - Mercedes Guerra-Rodríguez
- Unidad de Investigación de la Sociedad Española de Reumatología, Calle Marqués de Duero n°5, 28001 Madrid, Spain
| | - Fernando Sánchez-Alonso
- Unidad de Investigación de la Sociedad Española de Reumatología, Calle Marqués de Duero n°5, 28001 Madrid, Spain
| | - Clara Moriano
- Servicio de Reumatología, Complejo Asistencial Universitario de León, C/Altos de Nava, S/N, 24008 León, Spain
| | - Javier Loricera
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Spain
| | - Federico Díaz-González
- Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Spain; Servicio de Reumatología, Hospital Universitario de Canarias, Calle Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain.
| |
Collapse
|
5
|
Zeng Y, Zeng W, Yang B, Liu Z. Effectiveness of corticosteroids to treat coronavirus disease 2019 symptoms: A meta-analysis. Med Clin (Barc) 2022; 159:575-583. [PMID: 35618496 PMCID: PMC9061135 DOI: 10.1016/j.medcli.2022.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Currently, corticosteroids are widely used to treat coronavirus disease 2019 (COVID-19) symptoms. However, the therapeutic role of corticosteroids remains highly controversial. To that end, we aimed to assess the efficacy of corticosteroids in treating COVID-19 patients. METHOD We searched PubMed, Embase, and Cochrane Library to select suitable studies. Our primary study endpoint was all-cause mortality. The secondary study endpoint was the length of hospital stay. RESULTS A total of 9 randomized controlled trials (RCTs) with 7907 patients were assessed. The pooled result indicated that corticosteroids treatment could significantly reduce all-cause mortality in patients with COVID-19 (RR=0.88, 95% CI [0.82, 0.95], P=0.002). When subgroup analyses were performed, we found that corticosteroids were associated with decreased all-cause mortality in severe COVID-19 patients (RR=0.77, 95% CI [0.68, 0.88], P<0.0001), however no obvious difference was observed in all-cause mortality of non-severe COVID-19 patients between the corticosteroid and control group (RR=0.96, 95% CI [0.86, 1.06], P=0.41), meanwhile, a low dose (RR=0.89, 95% CI [0.82, 0.97], P=0.007) of dexamethasone (RR=0.9, 95% CI [0.83, 0.98], P=0.01) with a long treatment course (RR=0.89, 95% CI [0.82, 0.98], P=0.02) was beneficial for all-cause mortality in COVID-19 patients. Additionally, we found that corticosteroids might be associated with a longer length of hospital stay in non-severe COVID-19 patients (MD=3.83, 95% CI [1.11, 6.56], P=0.006). CONCLUSION Our results showed that corticosteroid therapy was related to a reduction in all-cause mortality in severe COVID-19 patients. However, in patients with non-severe COVID-19, the use of corticosteroids did not decrease all-cause mortality and may prolong the duration of hospital stay. In addition, we revealed that a low dose of dexamethasone with a long treatment course could reduce all-cause mortality in COVID-19 patients.
Collapse
Affiliation(s)
- Yiqian Zeng
- Department of Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Weizhong Zeng
- Department of Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Bihui Yang
- Department of Hematology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Zhao Liu
- Department of Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China,Corresponding author
| |
Collapse
|
6
|
Irigaray Echarri A, Ollero García-Agulló MD, Iriarte Beroiz A, García Mouriz M, Zazpe Cenoz I, Laguna Muro S, Muñoz de Dios L, Anda Apiñániz E. Evaluation of a perioperative steroid coverage after pituitary surgery. ENDOCRINOL DIAB NUTR 2022; 69:338-344. [PMID: 35538002 DOI: 10.1016/j.endien.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/01/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Serum cortisol levels within the first days after pituitary surgery have been shown to be a predictor of post-surgical adrenal insufficiency. However, the indication of empirical glucocorticoids to avoid this complication remains controversial. The objective is to assess the role of cortisol in the early postoperative period as a predictor of long-term corticotropic function according to the pituitary perisurgical protocol with corticosteroid replacement followed in our center. METHODS One hundred eighteen patients who underwent surgery in a single center between December 2012 and January 2020 for a pituitary adenoma were included. Of these, 54 patients with previous adrenal insufficiency (AI), Cushing's disease, or tumors that required treatment with high-dose glucocorticoids (GC) were excluded. A treatment protocol with glucocorticoids was established, consisting of its empirical administration at rapidly decreasing doses, and serum cortisol was determined on the third day after surgery. Subsequent adrenal status was assessed through follow-up biochemical and clinical evaluations. RESULTS Out of the 64 patients treated, there were 56 macroadenomas and 8 microadenomas. The incidence of adrenal insufficiency after pituitary surgery was 4.7%. The optimal cut-off value that predicted an adequate corticotropic reserve, taking into account the best relationship of specificity and sensitivity, was ≥4.1 μg/dl for serum cortisol on the third day (sensitivity 95.1%, specificity 100%). CONCLUSION Serum cortisol on the third day predicts the development of adrenal insufficiency. We suggest a cortisol cut-off point of ≥4.1 μg/dl on postoperative on the third day after surgery as a predictor of the adrenal reserve in the long-term.
Collapse
Affiliation(s)
- Ana Irigaray Echarri
- Sección de Endocrinología y Nutrición, Hospital García Orcoyen, Estella, Navarra, Spain.
| | | | - Ana Iriarte Beroiz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Marta García Mouriz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Idoya Zazpe Cenoz
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Sara Laguna Muro
- Sección de Endocrinología y Nutrición, Fundación Hospital de Calahorra, Calahorra, La Rioja, Spain
| | - Luis Muñoz de Dios
- Servicio de Endocrinología y Nutrición, Hospital San Pedro, Logroño, La Rioja, Spain
| | - Emma Anda Apiñániz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| |
Collapse
|
7
|
Villalobos F, Matellan C, Sequeira G, Kerzberg E. Drugs Recommended in Adult Rheumatic Diseases, But Considered for Off-Label Use in Argentina. Reumatol Clin (Engl Ed) 2022; 18:286-292. [PMID: 35568442 DOI: 10.1016/j.reumae.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/14/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Off-label (OL) drug use is the prescription of a drug for indications other than those authorised in its technical datasheet. The objective of this study was to identify drugs recommended in rheumatology but considered for off-label use in Argentina. METHODS A list of medications for certain selected rheumatic conditions was compiled. A drug was considered recommended if it was endorsed by a) at least one Argentine or Pan-American treatment guideline or consensus, or b) two international treatment guidelines, or c) one international treatment guideline and one selected textbook. Approval of these drugs for any condition in Argentina until December 31st, 2018 was explored, and medicines were divided into those with on-label indications and those considered for OL use. RESULTS One hundred and thirty-six medications were analysed in 13 clinical conditions. Sixty-seven OL recommendations (49%) were found, and several drugs had more than one. All the conditions included the recommendation of at least 1 OL drug except osteoporosis and rheumatoid arthritis. The frequency of OL recommendations for the following conditions was 100%: calcium pyrophosphate dihydrate crystal deposition disease, polymyalgia rheumatica, Sjögren syndrome, and systemic sclerosis. The drugs with the highest number of OL recommendations were methotrexate (in 7 conditions), and glucocorticoids and mycophenolate (in 4). There were 2 OL recommendations for rituximab and 1 for abatacept. CONCLUSIONS Almost all the rheumatic disorders analysed involved the recommendation of at least 1 OL medication, and in 4 conditions all the recommendations were OL. Most OL drugs recommended in rheumatology are neither biological nor small-molecule therapies.
Collapse
Affiliation(s)
- Fernando Villalobos
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carla Matellan
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Sequeira
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Eduardo Kerzberg
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
8
|
Correa-Rodríguez M, Callejas-Rubio JL, Rueda-Medina B, Ríos-Fernández R, Hera-Fernández J, Ortego-Centeno N. Clinical course of Covid-19 in a cohort of patients with Behçet disease. Med Clin (Barc) 2021:S0025-7753(21)00716-8. [PMID: 35058051 DOI: 10.1016/j.medcli.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. METHODS A retrospective study was conducted among 244 patients with BD (86.1% females; mean age 43.95±11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. RESULTS The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5mg/day of colchicine compared to those taking 1.5mg/day (p=0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p=0.032). With regards to oral glucocorticoids, no significant differences were found. CONCLUSIONS The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea; oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.
Collapse
|
9
|
Álvarez-Hernández E, Mercado-Molina G, Barrera-Guerra RC. Validity of the Cushing's Syndrome Severity Index in Patients with Iatrogenic Cushing's Syndrome. Reumatol Clin (Engl Ed) 2021; 17:313-317. [PMID: 31843277 DOI: 10.1016/j.reuma.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/09/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Currently there are no clinimetric instruments for the measurement of the severity of iatrogenic Cushing's syndrome (ICS). Sonino et al. created a clinical severity index of endogenous Cushing's disease (CSI) but it has not been applied to patients with ICS. OBJECTIVE To validate and determine the utility of the CSI and its correlation with clinical variables in rheumatological patients with continuous use of glucocorticoids (GC). SUBJECTS AND METHODS Patients with a history of continuous systemic GC use (for at least 4 weeks) indicated for treatment of rheumatological disease were included. All the patients filled out a questionnaire on sociodemographic data, characteristics of the CG used; the way of use and the presence or absence of adverse events. The CSI was applied by 2 observers independently. Consistency, interobserver concordance and principal component analysis were calculated. RESULTS A total of 32 patients with an average age of 35.72±12.8 years were studied; 29 were women (90.6%). The average CSI score by the first observer was 3.50±2.02, and by the second observer was 2.31±1.75 (p=.004). The interobserver concordance was low in the items with imprecise definitions; for which modifications were made in the definitions to improve their performance. The CSI scores correlated with the presence of adverse effects and the type of dose used. CONCLUSIONS The CSI has an adequate correlation with clinical manifestations in patients with chronic use of GC. The clinimetric characteristics of the questionnaire improved by standardising the definitions of subjective clinical variables.
Collapse
|
10
|
Villalobos F, Matellan C, Sequeira G, Kerzberg E. Drugs Recommended in Adult Rheumatic Diseases, But Considered for Off-Label Use in Argentina. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(21)00030-9. [PMID: 33640322 DOI: 10.1016/j.reuma.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/19/2020] [Accepted: 01/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Off-label (OL) drug use is the prescription of a drug for indications other than those authorised in its technical datasheet. The objective of this study was to identify drugs recommended in rheumatology but considered for off-label use in Argentina. METHODS A list of medications for certain selected rheumatic conditions was compiled. A drug was considered recommended if it was endorsed by a) at least one Argentine or Pan-American treatment guideline or consensus, or b) two international treatment guidelines, or c) one international treatment guideline and one selected textbook. Approval of these drugs for any condition in Argentina until December 31st, 2018 was explored, and medicines were divided into those with on-label indications and those considered for OL use. RESULTS One hundred and thirty-six medications were analysed in 13 clinical conditions. Sixty-seven OL recommendations (49%) were found, and several drugs had more than one. All the conditions included the recommendation of at least 1 OL drug except osteoporosis and rheumatoid arthritis. The frequency of OL recommendations for the following conditions was 100%: calcium pyrophosphate dihydrate crystal deposition disease, polymyalgia rheumatica, Sjögren syndrome, and systemic sclerosis. The drugs with the highest number of OL recommendations were methotrexate (in 7 conditions), and glucocorticoids and mycophenolate (in 4). There were 2 OL recommendations for rituximab and 1 for abatacept. CONCLUSIONS Almost all the rheumatic disorders analysed involved the recommendation of at least 1 OL medication, and in 4 conditions all the recommendations were OL. Most OL drugs recommended in rheumatology are neither biological nor small-molecule therapies.
Collapse
Affiliation(s)
- Fernando Villalobos
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carla Matellan
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Sequeira
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Eduardo Kerzberg
- Servicio de Reumatología, Hospital J. M. Ramos Mejia, Urquiza 609, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
11
|
Abstract
Graves' ophthalmopathy is an inflammatory disease with primary involvement of the extraocular muscles and the orbit. It encompasses the most common extra-thyroid manifestation in patients with Graves-Basedow disease. The underlying cause is molecular mimicry with the TSH receptor in ocular fibroblasts, leading to an immuno-mediated pathogenesis. Glucocorticoids at high doses are the cornerstone in moderate-severe cases. However, some patients are corticorresistant or intolerant. In recent years, therapeutic novelties have been described in terms of the dosage of the immunosuppressive treatments used, as well as the emergence of biological therapy in this field. The objective of this review is to update the treatment of Graves' ophthalmopathy, as well as to present alternative options in patients resistant or intolerant to glucocorticoids.
Collapse
Affiliation(s)
- Andrés González-García
- Unidad de Enfermedades Sistémicas Autoinmunes y Minoritarias, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
| | - Marco Sales-Sanz
- CSUR de tumores orbitarios y cirugía de descompresión orbitaria en Oftalmopatía Tiroidea. Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| |
Collapse
|
12
|
Rodríguez-Molinero A, Pérez-López C, Gálvez-Barrón C, Miñarro A, Rodríguez Gullello EA, Collado Pérez I, Milà Ràfols N, Mónaco EE, Hidalgo García A, Añaños Carrasco G, Chamero Pastilla A. [Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study]. Med Clin (Barc) 2020; 156:7-12. [PMID: 33129511 PMCID: PMC7518174 DOI: 10.1016/j.medcli.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Objetivo Analizar si existe asociación entre el uso de glucocorticoides a dosis altas y la evolución de la SAFI (saturación/fracción inspirada de oxígeno) o el tiempo hasta el alta, en pacientes hospitalizados por COVID-19. Métodos Estudio observacional sobre una cohorte de 418 pacientes ingresados en 3 hospitales comarcales de Cataluña (España). Como resultados primarios se estudiaron la evolución de la SAFI en las primeras 48 h de tratamiento y el tiempo hasta el alta. Los resultados se compararon entre pacientes tratados y no tratados con glucocorticoides (metilprednisolona 1-2 mg/kg/día o dexametasona 20-40 mg/día), mediante el análisis de subcohortes emparejadas por múltiples factores clínicos y pronósticos, así como mediante modelos multivariantes de Cox, ajustados por diversos factores pronósticos. El uso simultáneo de diferentes tratamientos para la COVID-19 fue tenido en cuenta, tanto en el emparejamiento de subcohortes como en la regresión de Cox. Resultados Hubo 187 pacientes con glucocorticoides; de ellos, 25 pacientes pudieron ser emparejados con un número equivalente de pacientes control. En las subcohortes emparejadas, no se apreció diferencia en el tiempo hasta el alta (log-rank: p = 0,291), ni en el cambio en la SAFI a las 48 h desde la basal (glucocorticoides: −0,04; controles: +0,37; p = 0,095). Los modelos multivariantes mediante regresión de Cox mostraron un tiempo hasta el alta significativamente más largo en pacientes tratados con glucocorticoides (hazard ratio: 7,26; IC 95%: 3,30-15,95). Conclusiones No hemos encontrado mejoría en la función respiratoria o tiempo hasta el alta, asociado al uso de glucocorticoides a dosis altas.
Collapse
Affiliation(s)
| | - Carlos Pérez-López
- Technical Research Centre for Dependency Care and Autonomous Living(CETpD), Universitat Politècnica de Catalunya, Vilanova i la Geltrú, Barcelona, España
| | - César Gálvez-Barrón
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | - Antonio Miñarro
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, España
| | | | - Isabel Collado Pérez
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | - Núria Milà Ràfols
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | - Ernesto E Mónaco
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | - Antonio Hidalgo García
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | - Gemma Añaños Carrasco
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | - Antonio Chamero Pastilla
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, España
| | | |
Collapse
|
13
|
Almorza Hidalgo T, García González AJ, Castañeda S, Tomero EG, Pablos Álvarez JL. Cogan syndrome: Descriptive analysis and clinical experience of 7 cases diagnosed and treated in two third level hospitals. ACTA ACUST UNITED AC 2021; 17:318-21. [PMID: 32571733 DOI: 10.1016/j.reuma.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Cogan's syndrome (CS) is an inflammatory disease classified as variable vessel vasculitis. It is a rare disease with few published series, and therefore we reviewed our experience in the last ten years in two centres. MATERIALS AND METHODS Description of 7 diagnosed cases of CS, according to the classification criteria (typical or atypical), their clinical manifestations, treatments used and their complications. A comparative analysis was performed with the series and cases described in the literature. RESULTS Seven cases were included, three men and four women, with a mean age at diagnosis of 43 years, and an average disease duration of 47 months. Five patients met the typical characteristics according to the 1980 classical criteria, the rest being atypical cases, one due to the absence of interstitial keratitis and another due to a period between the onset of ocular and auditory-vestibular clinical symptoms greater than two years. All received immunosuppressants, methotrexate being the most commonly used, followed by azathioprine. In 5 cases, biological drugs were used, infliximab in 4 times and 2 tocilizumab. One patient died from bacterial endocarditis and septic shock. CONCLUSION The characteristics of the series presented are like those published to date, with clinical differences mainly in the involvement of large vessels. Given the low frequency, it seems necessary to create multicentre records to improve the evidence regarding the management of patients with CS.
Collapse
|
14
|
Domínguez-Ortega J, Sáez-Martínez FJ, Gómez-Sáenz JT, Molina-París J, Álvarez-Gutiérrez FJ; en nombre del Grupo Unidos por el Asma., Grupo Unidos por el Asma. [The management of asthma as a chronic inflammatory disease and global health problem: A position paper from the scientific societies]. Semergen 2020; 46:347-54. [PMID: 32224055 DOI: 10.1016/j.semerg.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 10/24/2022]
Abstract
Asthma is the most prevalent respiratory disease worldwide and it can affect people of all ages and is potentially fatal. Today, maintenance treatments are available that are effective in most patients, yet a significant proportion have poorly controlled disease, despite the resources on offer. This document, endorsed by members of the Spanish medical societies involved in the treatment of asthma, is intended to draw the attention of society and professionals to this problem in Spain. It focuses on the clinical, diagnostic and therapeutic aspects of asthma, and proposes some actions for improvement as regards patients and healthcare professionals which, in view of the current results arising from inadequate asthma control, might be beneficial to improve outcomes for both patients and public health.
Collapse
|
15
|
Gallart Úbeda V, Elía Martínez JM, Puerta de Diego R, Elía Martínez I, Valero Inigo JC. [Multiple osteonecrosis. Update and case report]. Rehabilitacion (Madr) 2020; 54:63-67. [PMID: 32007184 DOI: 10.1016/j.rh.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
Multifocal osteonecrosis is defined as the presence of osteonecrosis in three or more osseous sites. It is an infrequent entity representing less than 3% of cases among osteonecrosis patients. Multifocal osteonecrosis has been associated with systemic diseases, with patients at highest risk being those with lupus erythematosus, transplant recipients and those with haematological disorders or prolonged high-dose glucocorticoid treatment. The area most prone to disturbances is the femoral head. The pathogenesis of this particular disorder has not been fully defined, although several risk factors have been identified. We report the case of a young woman with abnormal hemostatic factors and a history of glucocorticoid and oral contraceptive therapy who developed bilateral hip osteonecrosis, followed by shoulder ON. The present article also provides an extensive literature review of the aetiology and treatment of multifocal ON.
Collapse
Affiliation(s)
- V Gallart Úbeda
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - J M Elía Martínez
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - R Puerta de Diego
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - I Elía Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J C Valero Inigo
- Servicio de Anestesia y Reanimación, Hospital de Sagunto, Valencia, España
| |
Collapse
|
16
|
Agudo-Tabuenca A, Gimeno-Orna JA, Sáenz-Abad D. Assessment of the efficacy and safety of a protocol to manage glucocorticoid-induced hyperglycemia in diabetic patients during hospital stay. ACTA ACUST UNITED AC 2019; 66:353-360. [PMID: 30898606 DOI: 10.1016/j.endinu.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION There are no agreed protocols on hospital management of hyperglycemic decompensation induced by pharmacological doses of glucocorticoids (GCs). The study objective was to assess the efficacy and safety of an insulin therapy protocol specific for patients treated with glucocorticoids (CP) as compared to a general protocol (GP) in diabetes decompensation secondary to glucocorticoids. Materials and methods An experimental study in patients with glucocorticoids-induced decompensated diabetes admitted to a respiratory ward including a non-randomized control group. Two protocols (CP and GP), both based on basal-bolo insulin regimens, but with different insulin doses and distribution, were compared. The difference in mean blood glucose (MBG) levels between both protocols was measured during hospital stay, as was the risk of having MBG levels > 200mg/dL, adjusted for potential confounding factors (related to patients and to the glucocorticoid therapy used). RESULTS A total of 131 patients were included, 60 assigned to the GP and 71 to the CP groups. Seventy-four percent of patients had been admitted due to COPD exacerbation. There was a significant difference in the total daily insulin dose used between the CP and GP groups (29.4 vs. 57.4 IU; P<.0001). The adjusted difference in MBG levels (CP-GP) was -14.8 (95% CI, -26.2 to -3.3) mg/dL. Patients in the CP group had a lower adjusted risk of having MBG levels >200mg/dL during hospital admission (OR=0.31; 95% CI, 0.11-0.91; P=.033). There were no differences in the risk of severe hypoglycemia between the CP and GP groups (0% vs. 1.4%; P=.36). CONCLUSIONS The study protocol has been shown to decrease MBG levels in patients with glucocorticoids-induced decompensation of diabetes during hospital admission without compromising their safety.
Collapse
Affiliation(s)
- Ana Agudo-Tabuenca
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - José Antonio Gimeno-Orna
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Daniel Sáenz-Abad
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| |
Collapse
|
17
|
Braga BP, Prieto-González S, Hernández-Rodríguez J. Pneumocystis jirovecii pneumonia prophylaxis in immunocompromised patients with systemic autoimmune diseases. Med Clin (Barc) 2019; 152:502-507. [PMID: 30853123 DOI: 10.1016/j.medcli.2019.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 02/07/2023]
Abstract
Pneumocystis jirovecii (P. jirovecii) causes a potentially fatal pneumonia in immunocompromised individuals (Pneumocystis pneumonia or PcP), particularly in HIV-infected patients and those treated with immunosuppressive drugs, such as transplant patients and those with systemic autoimmune diseases. P. jirovecii colonization can be found in almost a third of patients with systemic autoimmune diseases. Although the incidence of PcP in such patients is usually low, mortality is quite high, ranging between 30% and 50% in the majority of autoimmune diseases. PcP development is almost always observed in patients not receiving prophylaxis for the infection. Despite the above, there are no clinical guidelines established for PcP prophylaxis in patients with autoimmune diseases treated with glucocorticoids, cytotoxic drugs, or more recently, biological agents. The objective of this review is to analyze the available data on the incidence of PcP and the effect of PcP prophylaxis in patients with autoimmune diseases that may be useful in clinical practice.
Collapse
Affiliation(s)
- Beatriz P Braga
- Department of Internal Medicine, Hospital do Divino Espírito Santo de Ponta Delgada, São Miguel, Portugal
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| |
Collapse
|
18
|
Sanmartí R, Tornero J, Narváez J, Muñoz A, Garmendia E, Ortiz AM, Abad MA, Moya P, Mateo ML, Reina D, Salvatierra-Ossorio J, Rodriguez S, Palmou-Fontana N, Ruibal-Escribano A, Calvo-Alén J. Efficacy and safety of glucocorticoids in rheumatoid arthritis: Systematic literature review. ACTA ACUST UNITED AC 2018; 16:222-228. [PMID: 30057295 DOI: 10.1016/j.reuma.2018.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES 1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); 2) to generate practical recommendations. METHODS A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. RESULTS A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. CONCLUSIONS These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA.
Collapse
Affiliation(s)
- Raimon Sanmartí
- Servicio de Reumatología, Hospital Clínic, Barcelona, España.
| | - Jesús Tornero
- Servicio de Reumatología, Departamento de Medicina y Especialidades Médicas, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España
| | - Javier Narváez
- Servicio de Reumatología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Alejandro Muñoz
- Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Elena Garmendia
- Servicio de Reumatología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - Ana M Ortiz
- Servicio de Reumatología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, España
| | - Miguel Angel Abad
- Servicio de Reumatología, Hospital Virgen del Puerto, Plasencia, Cáceres, España
| | - Patricia Moya
- Sección de Reumatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - María Lourdes Mateo
- Servicio de Reumatología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Delia Reina
- Servicio de Reumatología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | | | - Sergio Rodriguez
- Servicio de Reumatología, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Natalia Palmou-Fontana
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Cantabria, España
| | | | - Jaime Calvo-Alén
- Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| |
Collapse
|
19
|
Vico-Alonso C, Maroñas-Jiménez L, Lozano-Morillo F. Management of Corticosteroid-Induced Osteoporosis: A Practical Approach for the Dermatologist. Actas Dermosifiliogr (Engl Ed) 2017; 109:357-358. [PMID: 29162226 DOI: 10.1016/j.ad.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- C Vico-Alonso
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - L Maroñas-Jiménez
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Lozano-Morillo
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España
| |
Collapse
|
20
|
Rueda-Camino JA, Bernal-Bello D, Canora-Lebrato J, Velázquez-Ríos L, García de Viedma-García V, Guerrero-Santillán M, Duarte-Millán MA, Cristóbal-Bilbao R, Zapatero-Gaviria A. High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study. Rev Clin Esp 2017; 217:504-509. [PMID: 28865758 DOI: 10.1016/j.rce.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/06/2017] [Accepted: 07/30/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge. RESULTS We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors. CONCLUSIONS A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months.
Collapse
Affiliation(s)
- J A Rueda-Camino
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
| | - D Bernal-Bello
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - J Canora-Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - L Velázquez-Ríos
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | | | - M Guerrero-Santillán
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - M A Duarte-Millán
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - R Cristóbal-Bilbao
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - A Zapatero-Gaviria
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| |
Collapse
|
21
|
Ogata JFM, Fonseca MCM, Miyoshi MH, Almeida MFBD, Guinsburg R. Costs of hospitalization in preterm infants: impact of antenatal steroid therapy. J Pediatr (Rio J) 2016; 92:24-31. [PMID: 26133238 DOI: 10.1016/j.jped.2015.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS). METHOD Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique. RESULTS Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p=0.008). The survivors with gestational age <30 weeks showed a decrease in the total cost of 38% (p=0.008) and a 49% reduction of NICU length of stay (p=0.011). CONCLUSION ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and <30 weeks of gestational age.
Collapse
Affiliation(s)
- Joice Fabiola Meneguel Ogata
- Discipline of Neonatal Pediatrics, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Marcelo Cunio Machado Fonseca
- Discipline of Gynecology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Milton Harumi Miyoshi
- Discipline of Neonatal Pediatrics, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Fernanda Branco de Almeida
- Discipline of Neonatal Pediatrics, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ruth Guinsburg
- Discipline of Neonatal Pediatrics, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
22
|
Peñacoba Toribio P, Córica Albani ME, Mayos Pérez M, Rodríguez de la Serna A. Rituximab in the treatment of shrinking lung syndrome in systemic lupus erythematosus. ACTA ACUST UNITED AC 2013; 10:325-7. [PMID: 24315464 DOI: 10.1016/j.reuma.2013.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/18/2013] [Accepted: 09/26/2013] [Indexed: 11/27/2022]
Abstract
Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus. We report the case of a patient with non-responding SLS (neither to glucocorticoids nor immunosupresors), who showed remarkable improvement after the onset of treatment with rituximab. Although there is a little evidence, treatment with rituximab could be proposed in SLS when classical treatment fails.
Collapse
Affiliation(s)
| | - María Emilia Córica Albani
- Unidad de Reumatología, Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Mercedes Mayos Pérez
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CibeRes), Universidad Autónoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | |
Collapse
|
23
|
García-Magallón B, Silva-Fernández L, Andreu-Sánchez JL. Update on the use of steroids in rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 9:297-302. [PMID: 23726772 DOI: 10.1016/j.reuma.2013.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/30/2013] [Indexed: 11/17/2022]
Abstract
Corticosteroids are a mainstay in the therapy of rheumatoid arthritis (RA). In recent years, a number of high-quality controlled clinical trials have shown their effect as a disease-modifying anti-rheumatic drug (DMARD) and a favourable safety profile in recent-onset RA. Despite this, they are more frequently used as bridge therapy while other DMARDs initiate their action than as true disease-modifying agents. Low-dose corticosteroid use during the first two years of disease slows radiologic damage and reduces the need of biologic therapy aimed at reaching a state of clinical remission in recent-onset RA. Thus, their systematic use in this clinical scenario should be considered.
Collapse
Affiliation(s)
- Blanca García-Magallón
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | | | | |
Collapse
|