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Krishna GM, Dabas A, Mantan M, Kumar M A, Goswami B. Adrenocortical suppression in children with nephrotic syndrome treated with corticosteroids. Pediatr Nephrol 2024; 39:1817-1824. [PMID: 38253887 DOI: 10.1007/s00467-024-06294-9] [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: 08/10/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Children with nephrotic syndrome are exposed to alternate day steroids for prolonged periods and this poses the need for evaluation of adrenocortical suppression using the adrenocorticotropic hormone (ACTH) stimulation test. METHODS This cross-sectional study enrolled children (2-18 years) both with steroid sensitive nephrotic syndrome (SSNS) (n = 27) and steroid resistant (SRNS) (n = 25); those on daily prednisolone or having serious bacterial infections or hospitalized were excluded. The primary objective was to determine prevalence of adrenocortical suppression in those on low dose alternate day steroids for more than 8 weeks or having received > 2 mg/kg/d for > 2 weeks in the past 1 year and currently in remission. A baseline morning fasting sample of serum cortisol was taken and 25 IU of ACTH (Acton Prolongatum*) injected intramuscularly and repeat serum cortisol sample taken after 1 h. All patients with 1 h post ACTH cortisol < 18.0 µgm/dl were diagnosed with adrenal insufficiency. Receiver operating characteristic curve was drawn to predict the prednisolone dose for adrenal insufficiency. RESULTS Fifty-two (33 males) children were enrolled (mean age 9.4 years); proportion of adrenal insufficiency was 50% and 64% using baseline and post stimulation cutoffs. The total cumulative annual dose of prednisolone 0.22 mg/kg/day predicted adrenocortical suppression with AUC 0.76 (95% CI 0.63-0.89), with sensitivity of 63.9% and specificity of 81.3%. CONCLUSIONS A significant proportion of children with nephrotic syndrome were detected with adrenal insufficiency on ACTH stimulation test. A cumulative steroid intake of > 0.22 mg/kg/day on an alternate day basis emerged as a risk factor for predicting adrenocortical suppression.
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Affiliation(s)
- Ganesh M Krishna
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Mukta Mantan
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Akshay Kumar M
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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2
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Westerdijk K, Krens SD, Steeghs N, van der Graaf WTA, Tjwa ETTL, Westdorp H, Desar IME, van Erp NP. Real-world data on the management of pazopanib-induced liver toxicity in routine care of renal cell cancer and soft tissue sarcoma patients. Cancer Chemother Pharmacol 2024; 93:353-364. [PMID: 38104304 PMCID: PMC10951019 DOI: 10.1007/s00280-023-04615-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Pazopanib is known to cause liver toxicity. A relationship between pazopanib exposure and alanine transaminase elevations has been described in clinical trials. This study investigated the relation between pazopanib exposure and liver toxicity in real-world patients and evaluated the management of pazopanib-induced liver toxicity in routine care. METHODS A retrospective observational cohort study was performed in patients treated with pazopanib in whom pazopanib exposure was measured. The percentage of patients with and without liver toxicity during treatment with pazopanib was calculated as well as the average pazopanib exposure in both groups. Furthermore, the management of patients with liver toxicity was evaluated. RESULTS Liver toxicity was observed in 25 out of the 133 patients included (19%). Pazopanib exposure was comparable in patients with or without liver toxicity (27.7 mg/L versus 28.1 mg/L). Seven patients permanently discontinued pazopanib after the occurrence of liver toxicity. Of the remaining 18 patients, continuation or restart of pazopanib after liver toxicity was successful in 16 patients and half of these patients were able to safely continue pazopanib at the same dose as prior to liver toxicity for the remaining duration of treatment. CONCLUSION Our study did not demonstrate a clear relationship between pazopanib exposure and the occurrence of pazopanib-induced liver toxicity. Half of the patients were able to safely continue or restart pazopanib treatment after liver toxicity and received the same dose as prior to drug withdrawal. Successful interventions to address pazopanib-induced toxicity in the clinic led to an algorithm for the management of pazopanib-induced liver toxicity.
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Affiliation(s)
- K Westerdijk
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands.
| | - S D Krens
- Department of Clinical Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E T T L Tjwa
- Department of Gastroenterology and Hepatology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Westdorp
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands
| | - I M E Desar
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands
| | - N P van Erp
- Department of Clinical Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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Pan LY, Wang CW, Tsai TY, Chen SY, Sheng-Kai Ma K, Chung WH, Chen CB, Sun CC, Yeh LK, Chen HC, Hui-Kang Ma D. Post hoc Analysis of Role of Etanercept in Ocular Sequelae of Stevens-Johnson Syndrome. Ophthalmology 2024:S0161-6420(24)00204-5. [PMID: 38556174 DOI: 10.1016/j.ophtha.2024.03.023] [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: 06/18/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Li-Yen Pan
- Department of Ophthalmology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chuang-Wei Wang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Tsung-Ying Tsai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Shin-Yi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wen-Hung Chung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Xiamen Chang Gung Hospital, Xiamen, China; Limbal Stem Cell Laboratory, Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
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Inoue K, Hori S, Tomizawa M, Yoneda T, Nakai Y, Miyake M, Tanaka N, Fujimoto K. Risks of infection and severity of coronavirus disease 2019 in kidney transplant recipients: A single-center cohort study. Transpl Immunol 2024; 84:102023. [PMID: 38452985 DOI: 10.1016/j.trim.2024.102023] [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: 01/04/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The severity of coronavirus disease 2019 (COVID-19) is known to be high in kidney transplant recipients; however, the risk factors for COVID-19 infection in these patients has not been studied extensively. Therefore, we explored the predictors of COVID-19 infection and severity in kidney transplant recipients in Japan. METHODS This study included kidney transplant recipients who were regularly followed-up at our hospital from February 2021 to March 2023. We retrospectively reviewed the patients' medical charts; obtained their clinical information, including comorbidities, immunosuppressant usage, and presence of COVID-19 infection; and assessed the risk of COVID-19 infection and severity. Severe illness was defined as a decrease in oxygen saturation. RESULTS Among the 155 patients, 50 (32.3%) were infected with COVID-19. Multivariate analysis revealed that recipients taking >5 mg of prednisolone or taking tacrolimus instead of cyclosporine were at higher risk of infection (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.01-5.40; OR 2.29, 95% CI 1.03-5.07, respectively). Furthermore, of the 50 infected recipients, 42 had minor illness and eight had severe illness. Multivariate analysis revealed that recipients taking >5 mg of prednisolone were at a higher risk of severity (OR, 11.60, 95% CI 1.19-113.00). CONCLUSION In kidney transplant recipients, the infection rate and severity of COVID-19 tended to increase with higher maintenance doses of steroids. Recipients taking >5 mg of prednisolone should be considered a switch from tacrolimus to cyclosporine because cyclosporine may inhibit viral replication and reduce the risk of infection.
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Affiliation(s)
- Kuniaki Inoue
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
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Cardwell CR, McDowell RD, Hughes CM, Busby J, Murchie P. Oral prednisolone and warfarin and risk of oesophageal cancer: A case-control study. Cancer Epidemiol 2024; 90:102552. [PMID: 38447250 DOI: 10.1016/j.canep.2024.102552] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND A recent epidemiological study systematically screened 250 prescription medications for associations with oesophageal cancer risk, using Scottish data, and identified an increased risk with use of prednisolone and warfarin. We investigated whether oral prednisolone or warfarin use was associated with increased oesophageal cancer risk. METHODS A case-control study was conducted within the Clinical Practice Research Datalink. In the primary analysis oesophageal cancer cases were identified from linked cancer registry records. Up to 5 cancer-free controls were matched to each case (based upon sex, birth year, GP practice and year of GP registration). Prednisolone and warfarin medications were identified from prescribing records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression after adjusting for covariates including demographics, comorbidities and medication use. RESULTS There were 4552 oesophageal cancer cases and 22,601 matched control participants. Overall, there was no evidence of an increased risk of oesophageal cancer with oral prednisolone use (unadjusted OR=1.16 95% CI 1.06, 1.27 and adjusted OR=0.99 95% CI 0.89, 1.11) or warfarin use (unadjusted OR=1.12 95% CI 0.99, 1.28 and adjusted OR=1.08 95% CI 0.92, 1.27). CONCLUSIONS In this large population-based study, oral prednisolone and warfarin were not associated with oesophageal cancer risk.
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Affiliation(s)
- Chris R Cardwell
- Centre for Public Health, Queen's University, Grosvenor Rd., Belfast, Co., Antrim BT12 6 BA, UK.
| | - Ronald D McDowell
- Centre for Public Health, Queen's University, Grosvenor Rd., Belfast, Co., Antrim BT12 6 BA, UK; School of Psychology, Ulster University, Cromore Road, Coleraine BT52 1SA, UK
| | - Carmel M Hughes
- School of Pharmacy, Queen's University, Lisburn Rd, Belfast, Co, Antrim BT9 7BL, UK
| | - John Busby
- Centre for Public Health, Queen's University, Grosvenor Rd., Belfast, Co., Antrim BT12 6 BA, UK
| | - Peter Murchie
- Division of Applied Health Sciences Section, Academic Primary Care, Foresterhill, Aberdeen AB24 2ZD, UK
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Abdu SH, Alsubhi AH, Alzahrani A, Alshehri A, Al Taylouni N, Rammal A. Comparison of oral versus intravenous steroid in the management of Bell's palsy: a systematic review and meta-analysis of randomized clinical trials. Eur Arch Otorhinolaryngol 2024; 281:1095-1104. [PMID: 37940744 DOI: 10.1007/s00405-023-08288-z] [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: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Bell's palsy is a condition affecting cranial nerve VII that results in acute peripheral unilateral facial weakness or paralysis of unclear etiology. Corticosteroids are the primary therapy choice, because they improve outcomes. According to a recent study, prednisolone effectively treats Bell's palsy in the short and long term. This study aimed to assess the effectiveness and safety of Single-Dose Intravenous Methylprednisolone to Oral Prednisolone in treating Bell's palsy patients. METHODS PRISMA statement guidelines were used to design and conduct this systemic review. MEDLINE, Cochrane Library, and EMBASE databases were used in our search. We conducted the database search in November 2022. RESULTS Thirty-three publications were reviewed as a result of the literature review. Three studies were included in the meta-analysis after applying our criteria. 317 Bell's palsy patients were included in our study. Regarding complete recovery to grade 1 in 1 month, IV methylprednisolone was higher than oral prednisolone; (log OR = 0.52, 95% CI [0.08, 0.97], P = 0.022). However, at 3 months, the two groups had no significant difference. Patients with grade 4 Bell's palsy were more likely to fully recover to grade 1 in 1 month with IV methylprednisolone than with oral prednisolone (log OR = 0.73, 95% CI [0.19, 1.26], P = 0.008), but not for patients with grade 3 or grade 2 Bell's palsy. CONCLUSION This study shows evidence that patients with Bell's palsy can fully recover to grade 1 in 1 month when IV methylprednisolone is used instead of oral prednisolone. At 3 months, however, there was no discernible difference between the two treatments. Within 3 days of the onset of symptoms, IV methylprednisolone treatment can be started, which may help patients recover fully to grade 1 in 1 month. However, administering IV methylprednisolone may not always have long-term advantages compared to oral prednisolone.
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Affiliation(s)
- Shahad Hani Abdu
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Anas Alzahrani
- Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | | | | | - Almoaidbellah Rammal
- Department of Otolaryngology Head-Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Bakri MMH, Alabdali FH, Mahzari RH, Rajhi TJ, Gohal NM, Sufyani RA, Hezam AA, Qurishi AA, Bakri HM, Ali FM. Comparison of the effects of two different styles of orally prescribing prednisolone on postoperative sequelae of surgical extraction of an impacted mandibular third molar: a single-blind randomized study. J Korean Assoc Oral Maxillofac Surg 2024; 50:27-34. [PMID: 38419518 PMCID: PMC10910002 DOI: 10.5125/jkaoms.2024.50.1.27] [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: 11/24/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives Surgical intervention for removal of an impacted third molar can lead to significant pain and swelling. Corticosteroids show promise for mitigating postoperative sequelae across various surgical contexts. The use of corticosteroids following minor oral surgery, though controversial, has already been proven effective. However, little research has explored peroral prescription of corticosteroids despite its convenience for outpatients and for non-surgeons like implantologists and periodontists and others who don't have access to needle injections. The aim of this study was to address a void in the literature by comparing the effects of two styles of preoral administration of prednisolone after surgical removal of the mandibular third molar and to determine which style minimizes postoperative sequelae. Materials and Methods A randomized, split-mouth clinical study was conducted to investigate the efficacy of two different styles of preoral prednisolone in mitigating postoperative sequelae following surgical extraction of impacted mandibular third molars. Fifteen participants were enrolled in the study. Random selection was used to determine the prescription style for the right and left mandibular arch. Group A included those who received a single dose of prednisolone 25 mg, while group B received prednisolone 5 mg postoperatively for a period of three days (5 mg three times/day on the first postoperative day, 5 mg twice/day on the second postoperative day; 5 mg once/day on the third postoperative day). Results There was a significant difference in the distance between the corner of the mouth and tragus, which decreased with the time interval with respect to group B when compared to group A. Conclusion The present study showed that a three-day tapered dose of prednisolone postoperatively was more effective in reducing post-extraction sequelae than a single-dose regimen.
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Affiliation(s)
- Mohammed Mousa H. Bakri
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | | | | | | | | | - Asma Ali Hezam
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Ahtesham Ahmed Qurishi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Hamed Mousa Bakri
- Department of Periodontology and Implant Dentistry, Jazan Specialized Dental Center, Jazan, Saudi Arabia
| | - Fareedi Mukram Ali
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Gigi E, Lagopoulos V, Liakos A. Management of autoimmune hepatitis induced by hepatitis delta virus. World J Gastroenterol 2024; 30:799-805. [PMID: 38516234 PMCID: PMC10950643 DOI: 10.3748/wjg.v30.i8.799] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/26/2024] Open
Abstract
Approximately 12-72 million people worldwide are co-infected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). This concurrent infection can lead to several severe outcomes with hepatic disease, such as cirrhosis, fulminant hepatitis, and hepatocellular carcinoma, being the most common. Over the past few decades, a correlation between viral hepatitis and autoimmune diseases has been reported. Furthermore, autoantibodies have been detected in the serum of patients co-infected with HBV/HDV, and autoimmune features have been reported. However, to date, very few cases of clinically significant autoimmune hepatitis (AIH) have been reported in patients with HDV infection, mainly in those who have received treatment with pegylated interferon. Interestingly, there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants. Consequently, several questions remain unanswered with the challenge to distinguish whether it is autoimmune or "autoimmune-like" hepatitis being the most crucial. Second, it remains uncertain whether autoimmunity is induced by HBV or delta virus. Finally, we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon. These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV, such as Bulevirtide or immu-nosuppressive drugs, are more appropriate for the management of patients with HDV and AIH.
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Affiliation(s)
- Eleni Gigi
- Hepatology Unit, The Second Internal Medicine Department, Aristotle University Medical School, Hippokrateio General Hospital, Thessaloniki 54642, Greece
| | - Vasileios Lagopoulos
- Department of Surgical, AHEPA General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Hippokratio General Hospital, Aristotle University Thessaloniki, Thessaloniki 54642, Greece
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Tanaka R, Ota S, Taniguchi M, Koh J, Ito H, Murata S, Tanaka A. Recovery of cardiac metabolic function after high-dose prednisolone in a patient with inflammatory myopathy associated with anti-mitochondrial antibody. J Cardiol Cases 2024; 29:85-88. [PMID: 38362584 PMCID: PMC10865124 DOI: 10.1016/j.jccase.2023.10.014] [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: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024] Open
Abstract
Myocardial complications in the setting of inflammatory myopathy associated with anti-mitochondrial antibody (AMA) cause various cardiovascular complications. A 64-year-old Japanese man was diagnosed with inflammatory myopathy associated with AMA, and three years after diagnosis, the patient was referred to our hospital with leg edema and dyspnea on exertion. Right ventricular endomyocardial biopsy showed no disease-specific findings, with neither inflammatory cell infiltration nor non-caseating epithelioid cell granuloma, and only mild fibrosis; therefore, we finally diagnosed this patient with cardiac involvement in inflammatory myopathy associated with AMA. 123I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) cardiac scintigraphy showed decreased uptake in wider areas discordant with late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR). One month after starting prednisolone (PSL), the symptoms of congestive heart failure and left ventricular (LV) systolic function had improved. Additionally, BMIPP uptake in the LV myocardium significantly improved compared to that before PSL administration, although decreased BMIPP uptake remained in areas concordant with LGE on CMR. Moreover, it is suggested that recovery of cardiac metabolic function after high-dose PSL administration, which was confirmed through improvement in BMIPP uptake in the LV myocardium, may have led to the improvement in both LV systolic function and heart failure. Learning objective Although the definitive diagnosis of cardiac involvement in inflammatory myopathy associated with anti-mitochondrial antibody is difficult because of the rarity of this condition and no disease-specific findings in imaging and histology, physicians should consider this in patients with cardiac dysfunction and muscle weakness. 123I-β-methyl-p-iodophenyl-pentadecanoic acid scintigraphy should be used to assess cardiac metabolic function and treatment efficacy and should be considered for patient management.
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Affiliation(s)
- Rikuya Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mana Taniguchi
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Murata
- Department of Human Pathology and Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Arshad MF, Elder C, Newell-Price J, Ross R, Debono M. A retrospective study on weaning glucocorticoids and recovery of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab 2024:dgae059. [PMID: 38298131 DOI: 10.1210/clinem/dgae059] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/09/2024] [Accepted: 01/26/2024] [Indexed: 02/02/2024]
Abstract
CONTEXT Glucocorticoids suppress the hypothalamic-pituitary-adrenal (HPA) axis resulting in tertiary adrenal insufficiency (AI). When weaning patients off glucocorticoids there is no consensus on whether to maintain patients on prednisolone or convert to hydrocortisone. OBJECTIVE Investigate HPA axis recovery in patients on long-term prednisolone and assess outcome after hydrocortisone conversion. DESIGN Retrospective cohort study. SETTING Outpatient endocrine steroid clinic. PATIENTS Patients on long-term prednisolone referred for HPA axis testing between 2015-2022. MAIN OUTCOMES MEASURED 1) HPA axis recovery rate in patients on prednisolone demonstrated by normal ACTH stimulation test (AST).2) HPA axis recovery rate sub-analysis of dose-matched patients with confirmed tertiary AI on prednisolone or hydrocortisone. RESULTS 206 patients on prednisolone were tested for tertiary AI. Of these 176 remained on prednisolone while 30 were converted to hydrocortisone. The overall HPA axis recovery rate for patients on prednisolone after interval testing was 137/206 (66.5%). HPA axis recovery rate in dose-matched prednisolone and hydrocortisone conversion groups was 7/10 (70%) and 2/13 (15%) (p=0.008), respectively. There was no difference in mean (SD) age (67.1(12.2) v 63.4(11.1) years; p=0.464) and baseline cortisol (5.3(4.2) v 4.6(3.1)µg/dL; p=0.648) and median [IQR] glucocorticoids duration (1213[1114] v 2316[4808] days; p=0.693) and baseline ACTH (20.5[29.0] v 16.3[14.8]ng/L; p=0.905) between dose-matched prednisolone and hydrocortisone groups. Follow-up duration in prednisolone group was significantly lower (median [IQR] 348[975] v 667[884] days; p=0.012). CONCLUSIONS Patients with glucocorticoid induced AI maintained on once-daily prednisolone can recover HPA axis function when weaning. There is no apparent advantage to recover HPA axis function in converting to multiple dosing hydrocortisone.
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Affiliation(s)
- Muhammad Fahad Arshad
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charlotte Elder
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - John Newell-Price
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Richard Ross
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
| | - Miguel Debono
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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11
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Hata M, Mori T, Hirose Y, Nishida Y, Mandai S, Ando F, Susa K, Iimori S, Naito S, Sohara E, Rai T, Taguchi T, Tomii S, Ohashi K, Uchida S. A case of unexpected diagnosis of fibronectin glomerulopathy with histological features of membranoproliferative glomerulonephritis. BMC Nephrol 2024; 25:25. [PMID: 38254040 PMCID: PMC10802068 DOI: 10.1186/s12882-024-03456-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Fibronectin (FN) glomerulopathy (FNG), a rare autosomal hereditary renal disease, is characterized by proteinuria resulting from the massive accumulation of FN in the glomeruli. It typically affects individuals aged 10-50 years. In this report, we describe the case of a 57-year-old man who was diagnosed with FNG through genetic analysis and histological examination that revealed membranoproliferative glomerulonephritis. Despite treatment with prednisolone, the therapeutic response was unsatisfactory. Prednisolone was subsequently tapered and discontinued because the patient had pulmonary thromboembolism. Subsequent comprehensive genetic testing, which was initially not conducted because the patient's parents did not have a history of kidney disease, identified a known disease-causing variant in the FN1 gene, indicating a de novo variant. FNG was further confirmed by positive staining of glomeruli with FN using an IST-4 antibody. Although corticosteroid therapy is commonly employed as the initial treatment for MPGN, its appropriateness depends on the underlying etiology. Thus, clinicians must be aware of potential rare genetic causes underlying MPGN.
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Affiliation(s)
- Misa Hata
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Yurika Hirose
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuriko Nishida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Fumiaki Ando
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koichiro Susa
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Soichiro Iimori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tatemitsu Rai
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
| | - Towako Taguchi
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, TMDU, Tokyo, Japan
| | - Shohei Tomii
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, TMDU, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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12
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Mizuno J, Urabe Y, Oka S, Konishi H, Ishibashi K, Fukuhara M, Tanaka H, Tsuboi A, Yamashita K, Hiyama Y, Kotachi T, Takigawa H, Yuge R, Hiyama T, Tanaka S. Predictive factors for esophageal stenosis in patients receiving prophylactic steroid therapy after endoscopic submucosal dissection for esophageal squamous cell carcinoma. BMC Gastroenterol 2024; 24:41. [PMID: 38245690 PMCID: PMC10799525 DOI: 10.1186/s12876-024-03135-9] [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: 08/02/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Methods to prevent esophageal stenosis (ES) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) have received increasing attention. Although steroid administration is a prophylactic treatment, the risk factors for ES during prophylactic steroid therapy remain unknown. Therefore, this study aimed to retrospectively evaluate the risk factors for refractory ES in patients administered prophylactic steroids after ESD for ESCC. METHODS Among 795 patients with ESCC (854 lesions), 180 patients (211 lesions) administered local triamcinolone acetonide (TrA) and/or oral prednisolone were recruited for this study. We compared the total number of endoscopic balloon dilatation (EBD) procedures performed for post-ESD ES and clinical findings (tumor size, ESD history or chemoradiation therapy [CRT], entire circumferential resection, muscle layer damage, supplemental oral prednisolone administration, EBD with TrA injection, and additional CRT) between patients with refractory and non-refractory ES. EBD was continued until dysphagia resolved. We categorized cases requiring ≥ 8 EBD procedures as refractory postoperative stenosis and divided the lesions into two groups. RESULTS Multivariate logistic regression analysis revealed that factors such as ESD history, CRT history, tumor size, and entire circumferential resection were independently associated with the development of refractory ES. The withdrawal rates of EBD at 3 years were 96.1% (52/53) and 58.5% (39/59) in the non-refractory and refractory groups, respectively. CONCLUSIONS Our data suggest that entire circumferential resection and CRT history are risk factors for refractory post-ESD ES in ESCC, even with prophylactic steroid administration.
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Affiliation(s)
- Junichi Mizuno
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Hirona Konishi
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Kazuki Ishibashi
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Motomitsu Fukuhara
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiyoshi Tsuboi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuichi Hiyama
- Department of Hiroshima Clinical Research and Development Support Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryo Yuge
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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13
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Patil S, Patil MV, Bagalkotkar A, Wali S. Cyclophosphamide Toxicity in Pediatric Nephrotic Syndrome Patient: A Case Report and Literature Review. Curr Drug Saf 2024; 19:CDS-EPUB-137123. [PMID: 38204270 DOI: 10.2174/0115748863281214231213075642] [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: 09/08/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Primary membranous nephropathy is a rare presentation in children. Patients unresponsive to steroids and experiencing frequent relapse are considered steroid-resistant. They often require complex treatment regimens consisting of immunosuppressants like cyclophosphamide, tacrolimus, and cyclosporin A. CASE In the present case, a 5-year-old child was suffering from steroid-resistant nephrotic syndrome for the past 10 months. He was initially treated with prednisolone 20mg but was subsequently found to be steroid-resistant. A renal biopsy revealed primary podocytopathy with immunocomplex deposits in podocyte tissues, suggesting primary membranous nephropathy as the cause of SRNS (steroid-resistant nephrotic syndrome). Cyclophosphamide 25mg twice daily was added to the treatment plan since the child did not tolerate tacrolimus therapy. During a subsequent follow-up, the physician reduced the cyclophosphamide 25mg dose to once a day, but parents misinterpreted this, and the child received a larger dose, cyclophosphamide 25mg, four times a day for 20 days. This resulted in cyclophosphamide toxicity-induced neutropenia, alopecia and posing the child at greater risk of sepsis. CONCLUSION Nephrotic syndrome is a chronic disease that demands extensive treatment plans and strict monitoring. Medication errors are common among parents or caregivers of pediatric patients. This case is a take-home message emphasizing the significance of patient-centered communication in preventing medication errors. A clinical pharmacist can aid in conveying simple and unambiguous information to parents or caregivers.
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Affiliation(s)
- Soumya Patil
- Department of Pharmacy Practice, KLE College of Pharmacy, A Constituent Unit of KLE Academy of Higher Education and Research (KAHER), Belgaum-590010, Karnataka, India
| | - Mahantesh V Patil
- Department of Pediatrics, J N Medical College, A Constituent Unit of KLE Academy of Higher Education and Research (KAHER), Belgaum-590010, Karnataka, India
| | - Apoorva Bagalkotkar
- Department of Pediatrics, J N Medical College, A Constituent Unit of KLE Academy of Higher Education and Research (KAHER), Belgaum-590010, Karnataka, India
| | - Shashikala Wali
- Department of Pharmacy Practice, KLE College of Pharmacy, A Constituent Unit of KLE Academy of Higher Education and Research (KAHER), Belgaum-590010, Karnataka, India
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14
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Tengelmann C, Joos S, Kaußner Y, Malzahn U, Lunden L, Klug A, Häusler KG, Escales C, Maetzler W, Hügen K, Zolk O, Heuschmann PU, Förster C, Kaduszkiewicz H, Gágyor I. Feasibility, safety and effectiveness of prednisolone and vitamin B1, B6, and B12 in patients with post-COVID-19-syndrome (PreVitaCOV) - protocol of a randomised, double-blind, placebo-controlled multicentre trial in primary care (phase IIIb). BMC Infect Dis 2024; 24:56. [PMID: 38184567 PMCID: PMC10771676 DOI: 10.1186/s12879-023-08925-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND After infection with SARS-CoV-2 a relevant proportion of patients complains about persisting symptoms, a condition termed Post-COVID-19-syndrome (PC19S). So far, possible treatments are under investigation. Among others, neurotropic vitamins and anti-inflammatory substances are potential options. Thus, the PreVitaCOV trial aims to assess feasibility, safety, and effectiveness of treating patients in primary care with prednisolone and/or vitamin B1, B6 and B12. METHODS The phase IIIb, multi-centre randomised, double-blind, and placebo-controlled PreVitaCOV trial has a factorial design and is planned as a two-phase approach. The pilot phase assessed feasibility and safety and was transformed into a confirmatory phase to evaluate effectiveness since feasibility was proven. Adult patients with PC19S after a documented SARS-CoV-2 infection at least 12 weeks ago are randomly assigned to 4 parallel treatments: prednisolone 20 mg for five days followed by 5 mg for 23 days (trial drug 1), B vitamins (B1 (100 mg OD), B6 (50 mg OD), and B12 (500 µg OD)) for 28 days (trial drug 2), trial drugs 1 and 2, or placebo. The primary outcome of the pilot phase was defined as the retention rate of the first 100 patients. Values of ≥ 85% were considered as confirmation of feasibility, this criterion was even surpassed by a retention rate of 98%. After transformation, the confirmatory phase proceeds by enrolling 240 additional patients. The primary outcome for the study is the change of symptom severity from baseline to day 28 as assessed by a tailored Patient Reported Outcomes Measurement Information System (PROMIS) total score referring to five symptom domains known to be typical for PC19S (fatigue, dyspnoea, cognition, anxiety, depression). The confirmatory trial is considered positive if superiority of any treatment is demonstrated over placebo operationalised by an improvement of at least 3 points on the PROMIS total score (t-score). DISCUSSION The PreVitaCOV trial may contribute to the understanding of therapeutic approaches in PC19S in a primary care context. TRIAL REGISTRATION EudraCT: 2022-001041-20. DRKS: DRKS00029617. CLINICALTRIALS gov: F001AM02222_1 (registered: 05 Dec 2022).
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Affiliation(s)
- Caroline Tengelmann
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany
| | - Yvonne Kaußner
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Uwe Malzahn
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Laura Lunden
- Institute of General Practice, University of Kiel, Michaelisstraße 5, 24105, Kiel, Germany
| | - Andreas Klug
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Karl Georg Häusler
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 2, Building B1, 97080, Würzburg, Germany
| | - Catharina Escales
- Institute of General Practice, University of Kiel, Michaelisstraße 5, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller- Str. 3, Haus D, 24105, Kiel, Germany
| | - Klemens Hügen
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Immanuel Klinik Rüdersdorf, Seebad82/83, 15562, Rüdersdorf, Germany
| | - Peter U Heuschmann
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany.
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, Michaelisstraße 5, 24105, Kiel, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Straße 2, Building D7, 97080, Würzburg, Germany
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15
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Salehzadeh F, Molatefi R, Mardi A, Nahanmoghaddam N. Juvenile idiopathic recurrent parotitis (JIRP) treated with short course steroids, a case series study and one decade follow up for potential autoimmune disorder. Pediatr Rheumatol Online J 2024; 22:8. [PMID: 38178123 PMCID: PMC10765850 DOI: 10.1186/s12969-023-00946-0] [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: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Juvenile idiopathic recurrent parotitis (JIRP) in children is a condition characterized with recurrent episodes of idiopathic parotid gland inflammation. Since there are no definitive guidelines for diagnosis and management of this condition, we present a consecutive case series of patients with more than one decade follow up and their dramatic response to short course treatment by prednisolone. METHODS We conducted this study by retrospectively reviewed medical charts of children who were diagnosed with JIRP, from 1 January 2002 to 29 February 2023. We performed usual serological tests to exclude some possible background. We administered short course prednisolone on first day of episode as divided dosage (0.5 mg /kg). RESULTS In this case series of 10 patients (70%) were male, median age of onset was 5 years, duration of episodes 5 days, and the mean course of disease were 3.8 years. The average follows up of patients was near 10 years. In comparison with their natural course of disease all patients showed a dramatic response to treatment on the first day of administration of prednisolone (P Value 0.005). For ten years follow up there was not any additional accompanying autoimmune disorder. CONCLUSION Short course prednisolone on first day of each episode and its dramatic and meaningful response in our patients, introduce a new, effective, fast, and inexpensive regimen of therapy in patients with JIRP.
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Affiliation(s)
- Farhad Salehzadeh
- Pediatric Rheumatology, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Rasol Molatefi
- Pediatric Allergy and Immunology, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran.
| | - Ali Mardi
- Pediatric Gastroenterology, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Negin Nahanmoghaddam
- Pediatric Infectious Disease, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
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16
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Lund-Andersen C, Klefter ON, Schneider M. Long-term follow-up of a bilateral acute posterior multifocal placoid pigment epitheliopathy following COVID-19 infection: a case report. J Ophthalmic Inflamm Infect 2024; 14:2. [PMID: 38177891 PMCID: PMC10766895 DOI: 10.1186/s12348-023-00382-x] [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: 09/04/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disorder that is characterized by the presence of multiple placoid lesions in the posterior pole of the eye. Relentless placoid chorioretinitis (RPC) is an inflammatory chorioretinopathy that combines clinical features of APMPPE and serpiginous chorioretinitis, which is a progressive condition with a high risk of visual disability. Patients with COVID-19 can develop various ocular manifestations, however, there have been limited reports of APMPPE and RPC associated with the infection. We report a case of a patient who developed APMPPE after a COVID-19 infection and subsequently progressed into RPC. CASE PRESENTATION A 17-year-old male presented with a one-week history of painless gradual visual loss in both eyes. Two months prior to the visual symptoms, the patient had a SARS CoV-2 infection, confirmed by polymerase chain reaction test. Clinical findings with fundoscopy, optical coherence tomography and fluorescein angiography were consistent with APMPPE. Due to the severely affected vision in both eyes, the patient was started on 50 mg oral prednisolone daily, after which vision began to improve rapidly. Two months after symptom onset during steroid taper, the impression of continued inflammatory activity and new lesions in the retinal periphery of both eyes suggested RPC. Adalimumab 40 mg every other week was initiated with 12.5 mg prednisolone daily followed by slow tapering. Vision improved and five months after the start of the adalimumab treatment, the steroid was discontinued and there were no signs of active inflammation. The patient has been followed for a total of 21 months since presentation, had full visual recovery and good tolerance of the immunosuppressive treatment. CONCLUSION COVID-19 might cause long-lasting activity of APMPPE. The scarcity of reports compared with the number of confirmed COVID-19 infections worldwide suggests a rare entity. The association of APMPPE with a variety of infections may suggest a common immunological aberrant response that might be triggered by various factors. Further examinations and case reports are needed to understand the role of biological therapy in the treatment of such cases.
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Affiliation(s)
- Casper Lund-Andersen
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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17
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Kyler KE, Szefler SJ. Fifty Years of Unraveling the Clinical Pharmacology of Corticosteroids. J Pharm Sci 2024; 113:47-54. [PMID: 37844761 DOI: 10.1016/j.xphs.2023.10.016] [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: 08/15/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
This review will highlight portions of Dr. William Jusko's and colleagues' work that affected the clinical use and study of corticosteroids in acute and chronic disease management. Selected publications related to corticosteroid pharmacokinetics and pharmacodynamics from the 1970s through today were included in this review, with a focus on the foundational human-based studies conducted in the 1970s-1990s. Dr. Jusko contributed significantly to early corticosteroid pharmacology across several domains including: 1) foundational corticosteroid pharmacokinetic methods and parameter development, 2) disease state-variation in corticosteroid pharmacokinetics, 3) drug interaction effects on corticosteroid pharmacokinetics, and 4) early corticosteroid pharmacodynamic studies. In an era where little was known about the pharmacokinetics and pharmacodynamics of corticosteroids, Dr. Jusko's work opened the eyes of researchers and clinicians to the potential for disease and drug interactions that could reduce or enhance the effects of corticosteroids. This significant body of work paved the way for alternative routes of administration that would be useful in concentrating the activity at the site of action and markedly reduced systemic drug exposure, minimizing the risk of adverse effects through application of the dose-sparing pharmacokinetic and pharmacodynamic principles.
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Affiliation(s)
- Kathryn E Kyler
- Division of Hospital Medicine, Children's Mercy Kansas City, Kansas City, MO, United States; School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Stanley J Szefler
- University of Colorado School of Medicine, Department of Pediatrics Pediatric Pulmonary and Sleep Medicine Section, United States; Children's Hospital Colorado, Breathing Institute, United States.
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18
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Larsen BS, Kissi E, Nogueira LP, Genina N, Tho I. Impact of drug load and polymer molecular weight on the 3D microstructure of printed tablets. Eur J Pharm Sci 2024; 192:106619. [PMID: 37866675 DOI: 10.1016/j.ejps.2023.106619] [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: 05/31/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
This study investigates the influence of drug load and polymer molecular weight on the structure of tablets three-dimensionally (3D) printed from the binary mixture of prednisolone and hydroxypropyl methylcellulose (HPMC). Three different HPMC grades, (AFFINISOLTM HPMC HME 15LV, 90 Da (HPMC 15LV); 100LV, 180 Da (HPMC 100LV); 4M, 500 Da (HPMC 4M)), which are suitable for hot-melt extrusion (HME), were used in this study. HME was used to fabricate feedstock material, i.e., filaments, at the lowest possible extrusion temperature. Filaments of the three HPMC grades were prepared to contain 2.5, 5, 10 and 20 % (w/w) prednisolone. The thermal degradation of the filaments was studied with thermogravimetric analysis, while solid-state properties of the drug-loaded filaments were assessed with the use of X-ray powder diffraction. Prednisolone in the freshly extruded filaments was determined to be amorphous for drug loads up to 10%. It remained physically stable for at least 6 months of storage, except for the filament containing 10% drug with HPMC 15LV, where recrystallization of prednisolone was detected. Fused deposition modeling was utilized to print honeycomb-shaped tablets from the HME filaments of HPMC 15LV and 100LV. The structural characteristics of the tablets were evaluated using X-ray microcomputed tomography, specifically porosity and size of structural elements were investigated. The tablets printed from HPMC 15LV possessed in general lower total porosity and pores of smaller size than tablets printed from the HPMC 100LV. The studied drug loads were shown to have minor effect on the total porosity of the tablets, though the lower the drug load was, the higher the variance of porosity along the height of the tablet was observed. It was found that tablets printed with HPMC 15LV showed higher structural similarity with the virtually designed model than tablets printed from HPMC 100LV. These findings highlight the relevance of the drug load and polymer molecular weight on the microstructure and structural properties of 3D printed tablets.
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Affiliation(s)
- Bjarke Strøm Larsen
- Department of Pharmacy, University of Oslo, Sem Sælands vei 3, 0371 Oslo, Norway.
| | - Eric Kissi
- Department of Pharmacy, University of Oslo, Sem Sælands vei 3, 0371 Oslo, Norway; Nanoform Finland PLC, Viikinkaari 4, 00790 Helsinki, Finland
| | - Liebert Parreiras Nogueira
- Oral Research Laboratory, Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Geitmyrsveien 71, 0455 Oslo, Norway
| | - Natalja Genina
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - Ingunn Tho
- Department of Pharmacy, University of Oslo, Sem Sælands vei 3, 0371 Oslo, Norway
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19
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Schofield RC, Scordo M, Shah G, Carlow DC. Simultaneous Determination of Prednisone and Prednisolone in Serum by Turbulent Flow Liquid Chromatography-Tandem Mass Spectrometry. Methods Mol Biol 2024; 2737:413-422. [PMID: 38036842 DOI: 10.1007/978-1-0716-3541-4_38] [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] [Indexed: 12/02/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapeutic treatment for patients with high-risk hematologic malignancies and bone marrow failure syndromes. While allo-HCT can be highly effective, it is met with significant regimen-related toxicities and complications such as graft-versus-host disease (GVHD), poor immune reconstitution, and infections. Prednisone is the preferred treatment for patients with both acute and chronic GVHD. While effective, high-dose prednisone can cause many complications, including weight gain, skin fragility, muscle weakness, bone demineralization, hyperglycemia, insomnia, and psychosis. Optimizing prednisone (and prednisolone) dosing by measuring their concentrations and calculating their pharmacokinetic parameters will allow for personalized treatments for patients, producing more effective and safer treatments for GVHD. This chapter describes a method to measure both compounds simultaneously. Prednisone and prednisolone are extracted from serum by the addition of methanol containing deuterated internal standards. Chromatographic separation is achieved using a reversed-phase HPLC column followed by tandem mass spectrometry performed in the positive ion mode. This assay is fast, accurate, sensitive and allows for rapid drug measurements and timely dose modifications.
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Affiliation(s)
- Ryan C Schofield
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Gunjan Shah
- Adult Bone Marrow Transplant Service, Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dean C Carlow
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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20
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Kawasaki Y, Nishiki K, Ishizaki T. Successful treatment with dupilumab in mepolizumab-resistant allergic bronchopulmonary aspergillosis. Respir Med Case Rep 2023; 47:101964. [PMID: 38192543 PMCID: PMC10772803 DOI: 10.1016/j.rmcr.2023.101964] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
A 67-year-old woman with a history of poorly controlled asthma was admitted to our hospital with a persistent cough and abnormal chest radiographic findings. Her diagnosis was allergic bronchopulmonary aspergillosis (ABPA). Following treatment with mepolizumab, her symptoms and imaging findings improved initially. However, after approximately 2 years, the patient experienced a recurrent cough with elevated non-specific immunoglobulin E levels and worsening chest imaging findings, thereby changing her diagnosis to recurrent ABPA. Mepolizumab was substituted with dupilumab, and her subjective symptoms and imaging findings improved. Our findings suggest that dupilumab may be effective in ABPA cases following the failure of another antibody therapy.
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Affiliation(s)
- Yasutaka Kawasaki
- Department of Internal Medicine, Wajima Municipal Hospital, Wajima-shi, Japan
| | - Kazuaki Nishiki
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
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21
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Jha SS. Glucocorticoid-Induced Osteoporosis (GIOP). Indian J Orthop 2023; 57:181-191. [PMID: 38107807 PMCID: PMC10721764 DOI: 10.1007/s43465-023-01037-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023]
Abstract
Use of glucocorticoid in various diseases including rheumatology and respiratory diseases is on the rise because of its prompt beneficial effects. This culminates in osteoporosis and fragility fractures. Judicious use of glucocorticoid hence calls for attention with regard to the dose schedule, route of administration and accompanying enhancing factors. Institution of proper therapeutic management as per WHO risk stratification with anabolic and/or resorptive drugs like bisphosphonates, teriparatide or denosumab is necessary to prevent the eventuality of fragility fractures. Even otherwise, knowledge of glucocorticoid, its metabolism, various dose schedules, adverse effects are areas worth discussing.
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Affiliation(s)
- S. S. Jha
- Harishchandra Institute of Orthopaedics and Research, Patna, India
- IOA Orthopaedic Rheumatology Subcommittee, New Delhi, India
- IOA Osteoporosis Subcommittee, New Delhi, India
- Innovative Education and Scientific Research Foundation, New Delhi, India
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22
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Komeda Y, Tribonias G, Kono M, Handa K, Omoto S, Takenaka M, Hagiwara S, Tsuji N, Nishida N, Kashida H, Kudo M. Real-World Data on Short-Term and Long-Term Treatment Results of Ustekinumab in Patients with Steroid-Resistant/Dependent Ulcerative Colitis. Inflamm Intest Dis 2023; 8:161-166. [PMID: 38115909 PMCID: PMC10727513 DOI: 10.1159/000534457] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Ustekinumab is an IgG1 kappa monoclonal antibody directed against the common p40 subunit of interleukin-12 and interleukin-23, which activate Th1- and Th17-mediated immune responses, respectively. It has proven efficacy for the treatment of moderate to severe ulcerative colitis (UC) in the UNIFI phase III clinical trial; however, data on its efficacy in the real world are limited. In this study, we aimed to assess the real-world efficacy of ustekinumab. Methods This observational study included 30 patients with UC who received ustekinumab from April 2020 to April 2022. We examined demographic information, disease type and activity (Mayo score, partial Mayo score [PMS]), use of biologics, concomitant use of predonisolone (PSL), 8-week ustekinumab clinical response rate, remission induction rate, 44- and 152-week remission maintenance rate, continuation rate, and 44-week steroid-free remission rate. The primary outcomes were the short- and long-term efficacy of ustekinumab. Results Included patients (53% women; mean age: 41.2 years [16-80 years]) had an average disease duration of 86 weeks. The Mayo score (median) was 7.4 and the PMS was 5.4. Two (7%), 24 (80%), and four (13%) patients had a Mayo endoscopic subscore (MES) of MES1, MES2, and MES3, respectively. The median serum CRP was 1.0 mg/dL. Five patients had no history of biotherapy (naive), while eight and 17 had a history of one and two or more biologic agents, respectively. Eight patients were PSL-resistant and 22 were PSL-dependent. The 8-week clinical response rate was 73% and the clinical remission induction rate was 70%. The remission maintenance rates at 44 and 152 weeks were 67% and 63%, respectively. The ustekinumab retention rate was 67% (86-week mean follow-up period). Regarding biologic failure cases, the clinical response rate in the failure group with up to one biologic agent (including naive cases) was 84.6%, which was higher than the 58.0% rate in the failure group with two or more biologic agents (p = 0.06). Steroid-free remission rates at 44 and 152 weeks were 63% each. In the logistic regression analysis parameters for discontinuation of ustekinumab, only PMS remained significant after multivariate analysis (p = 0.018). Conclusion Our study showed short-term and long-term ustekinumab effectiveness, especially with comparative low disease activity.
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Affiliation(s)
- Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - George Tribonias
- Department of Gastroenterology, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece
| | - Masashi Kono
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kohei Handa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Naoko Tsuji
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
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23
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Al-Janabi A, Sharief L, Al Qassimi N, Chen YH, Ding T, Ambler G, Ladas D, Lightman S, Tomkins-Netzer O. Can Simvastatin Reduce the Need for Immunomodulatory Drugs to Treat Uveitis?: A Prospective, Randomized, Placebo-Controlled Trial. Ophthalmol Sci 2023; 3:100333. [PMID: 37449048 PMCID: PMC10336795 DOI: 10.1016/j.xops.2023.100333] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023]
Abstract
Objective To assess the efficacy of simvastatin 80 mg/day versus placebo in patients with noninfectious nonanterior uveitis receiving prednisolone ≥ 10 mg/day. Design Randomized, double-masked, controlled trial. Subjects Adult patients with noninfectious nonanterior uveitis on oral prednisolone dose of ≥ 10 mg/day. Methods Patients were randomly assigned at a 1:1 ratio to receive either simvastatin 80 mg/day or placebo. A total of 32 patients were enrolled (16 in each arm), all of whom completed the primary end point, and 21 reached the 2-year visit (secondary end points). Main Outcome Measures The primary end point was mean reduction in the daily prednisolone dose at 12 months follow-up. Secondary end points were mean reduction in prednisolone dose at 24 months, percent of patients with a reduction in second-line immunomodulatory agents, time to disease relapse, and adverse events. Results Our results show that simvastatin 80 mg/day did not have a significant corticosteroid-sparing effect at 12 months (estimate: 3.62; 95% confidence interval [CI]: -8.15 to 15.38; P = 0.54). There was no significant difference between the groups with regard to prednisolone dose or change in dose at 12 and 24 months. There was no difference between the 2 groups in percent of patients with reduction in second-line agent by 24 months. Among patients who achieved disease quiescence, the median time to first relapse was longer for those receiving simvastatin (38 weeks, 95% CI: 14-54) than placebo (14 weeks, 95% CI: 12-52), although this was not statistically significant. There was no significant difference in adverse events or serious adverse events between the 2 groups. Conclusions Simvastatin 80 mg/day did not have an effect on the dose reduction of corticosteroids or conventional immunomodulatory drugs at 1 and 2 years. The results suggest that it may extend the time to disease relapse among those who achieve disease quiescence. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ahmed Al-Janabi
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Lazha Sharief
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Noura Al Qassimi
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Yi-Hsing Chen
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Tao Ding
- Department of Statistical Science, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Dimitris Ladas
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, UCL/Institute of Ophthalmology, London, UK
- Department of Ophthalmology, Carmel Medical Center, Technion, Haifa, Israel
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24
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Takeda M, Tsukui T, Cazares J, Tsuboi K, Ochi T, Shibuya S, Koga H, Lane GJ, Yamataka A. Prednisolone administration monitored by postoperative stool color achieves high jaundice clearance after laparoscopic portoenterostomy for biliary atresia. Pediatr Surg Int 2023; 39:299. [PMID: 37985521 DOI: 10.1007/s00383-023-05580-1] [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] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Stool color (SC) for monitoring prednisolone use in biliary atresia (BA) patients after laparoscopic portoenterostomy (LPE) was reviewed. METHODS Subjects were 47 post-LPE BA patients given a reducing dose course of intravenous prednisolone. The course started at 4 mg/kg/day and gradually reduced, ultimately reaching a final total dose (TD) of 31.5 mg/kg. Normal SC indicated a course could progress until finished and was repeated until jaundice clearance (JC) was achieved. Abnormal SC persisting for two consecutive courses was the absolute indication for redo or liver transplantation (LTx). RESULTS JC was achieved in 38/47 (80.9%) LPE cases and 4/6 redos to give an overall JC rate (JCR) of 42/47 (89.4%). Outcomes after one course (n = 5; JCR: 80.0%; median TD: 30.0 mg/kg, interquartile range [IQR: 26.0-31.5]), two courses (n = 10; JCR: 90.0%; median TD: 62.5 mg/kg [IQR: 60.8-66.0]), three courses (n = 13; JCR: 92.3%; median TD: 90.0 mg/kg [IQR: 86.0-90.0]), four courses (n = 10; JCR: 80.0%; median TD: 120.0 mg/kg [IQR: 116.7-123.3]), five courses (n = 7; JCR: 100%; median TD: 156.0 mg/kg [IQR: 154.3-157.5]), six courses (n = 1; JCR: 100%; TD: 189.0 mg/kg), ten courses (n = 1; JCR: 100%; TD: 308 mg/kg). CONCLUSION Indications for repeat prednisolone and timing of redo/LTx based on SC monitoring appeared effective based on high JCR and successful redo/LTx. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Masahiro Takeda
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takafumi Tsukui
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Joel Cazares
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico
| | - Koichi Tsuboi
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Soichi Shibuya
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Aslan K, Kasapoglu I, Cinar C, Cakir C, Avci B, Uncu G. Low Molecular Weight Heparin-Aspirin- Prednisolone Combination Does Not Increase the Live Birth Rate in Recurrent Implantation Failure: A Retrospective Cohort Study. Reprod Sci 2023; 30:3253-3260. [PMID: 37253934 DOI: 10.1007/s43032-023-01233-9] [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: 08/02/2022] [Accepted: 03/30/2023] [Indexed: 06/01/2023]
Abstract
This study investigates the triple combination of adjuvants (low molecular weight heparin (LMWH)-aspirin-prednisolone) whether it improves the live birth rates of IVF&ICSI patients with previous implantation failure. This retrospective study included 1095 patients with >2 failed either fresh or frozen single embryo transfer cycles between 2014 Jan and 2021 Jan. Patients were divided into two subgroups. Group A consisted of patients with only vaginal progesterone for luteal phase support. Group B consisted of patients with triple (daily subcutaneous LMWH, daily 150 mg aspirin, and daily 16 mg prednisolone) luteal phase supplementation to vaginal progesterone. Demographic parameters, cycle characteristics, embryology, and pregnancy outcomes were compared, and the study's primary outcome was the live birth rate. Demographic parameters were similar between the groups. Positive b-hCG, miscarriage, and live birth rates were similar between groups as Group A vs. Group B, positive b-hCG 30.8% (190/617) vs. 35.4% (169/478), miscarriage rates 4.4% (27/617) vs. 6.7% (32/478), and live birth rates 20.4% (126/617) vs. 23.8% (114/478), respectively. When patients were stratified according to previous failures, live birth rates were still similar. Pregnancy outcomes were significantly improved in only patients with diminished ovarian reserve (Group A vs. Group B, positive b-hCG 24.2% vs. 34.3%, live birth rate 12.1% vs. 21.9%, p < 0.01). Whether the embryo transfer was fresh or frozen-thawed did not affect the results. A combined supplementation of LMWH, aspirin, and prednisolone in the luteal phase does not improve live birth rates of IVF&ICSI patients with previous implantation failure except potentially for patients with diminished ovarian reserve.
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Affiliation(s)
- Kiper Aslan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bursa Uludag University, Bursa, Turkey
| | - Isil Kasapoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bursa Uludag University, Bursa, Turkey
| | - Ceren Cinar
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bursa Uludag University, Bursa, Turkey
| | - Cihan Cakir
- Faculty of Medicine, Department of Histology and Embryology, Bursa Uludag University, Bursa, Turkey
| | - Berrin Avci
- Faculty of Medicine, Department of Histology and Embryology, Bursa Uludag University, Bursa, Turkey
| | - Gurkan Uncu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bursa Uludag University, Bursa, Turkey.
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Tokuyasu H, Watanabe H, Sueda Y, Sakai H, Omura-Tanaka N, Nakajima K, Nakamatsu S, Esumi C, Yamasaki A. Comparison of pathological findings and accumulation of fluorin-18 fluorodeoxyglucose on positron emission tomography/computed tomography: A case of relapsing polychondritis. Respir Med Case Rep 2023; 46:101937. [PMID: 37965629 PMCID: PMC10641241 DOI: 10.1016/j.rmcr.2023.101937] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
A 70-year-old woman with a hoarse voice and dry cough was referred to our hospital. Positron emission tomography/computed tomography showed abnormal accumulation of fluorine-18 fluorodeoxyglucose (FDG) at the nasal septum, larynx, trachea, bronchus, and costal cartilages. The maximum standard uptake values of FDG accumulation in the nasal septum and costal cartilage were similar. Biopsies of the nasal septum and costal cartilage were performed. The patient was diagnosed with relapsing polychondritis (RP) based on the clinical features and pathological findings. Histopathological examination revealed progressive initial RP findings. The disease progression was different, even with the same FDG accumulation.
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Affiliation(s)
- Hirokazu Tokuyasu
- Department of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Haruka Watanabe
- Department of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Yuriko Sueda
- Department of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Hiromitsu Sakai
- Department of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | | | | | - Satoru Nakamatsu
- Department of Radiology, Matsue Red Cross Hospital, Shimane, Japan
| | - Chika Esumi
- Department of Pathology, Matsue Red Cross Hospital, Shimane, Japan
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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Truthmann J, Freyer Martins Pereira J, Richter A, Schuster F, Witte A, Böhm S, Greser A, Kamin P, Stracke S, Dörr M, Bülow R, Engeli S, Gágyor I, Hummers E, Chenot JF. Prednisolone Versus Colchicine for Acute Gout in Primary Care (COPAGO): protocol for a two-arm multicentre, pragmatic, prospective, randomized, double-blind, controlled clinical trial of prednisolone and colchicine for non-inferiority with a parallel group design. Trials 2023; 24:643. [PMID: 37798801 PMCID: PMC10557330 DOI: 10.1186/s13063-023-07666-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Gout is the most common form of rheumatic disease in which monosodium urate crystals are deposited in the joints followed by acute inflammatory reactions. There are various approved drugs that can be prescribed for pain relief during an acute gout attack. However, to date, no direct comparison of efficacy of colchicine and prednisolone for the treatment of acute gout attacks has been investigated. Furthermore, the majority of previous research studies were not only conducted in tertiary centres but also excluded patients with common comorbidities due to contraindications to naproxen. METHODS This pragmatic, prospective, double-blind, double-dummy, parallel-group, randomized, non-inferiority trial investigates whether prednisolone (intervention) is non-inferior to treatment with colchicine (active control) in patients with acute gout. Adult patients presenting with acute gout to their general practitioners in 60 practices across 3 university sites (Greifswald, Göttingen, and Würzburg) are eligible to participate in the study. Participants in the intervention group receive 30 mg prednisolone for 5 days. Those in the control group receive low-dose colchicine (day 1: 1.5 mg; days 2-5: 1 mg). The primary outcome is the absolute level of the most severe pain on day 3 (in the last 24 h) measured with an 11-item numerical rating scale. Day 0 is the day patients take their study medication for the first time. They are then asked to fill out a study diary the same time each day for pain quantification. Pain scores are used for comparison between the two medications. Secondary outcomes are average response to treatment, swelling, tenderness and physical function of the joint, patients' global assessment of treatment success, use of additional pain medication and non-pharmacological pain therapies. For safety reasons, potential side effects and course of systolic blood pressure are assessed. DISCUSSION This trial will provide evidence on the effectiveness of pain reduction and side effects of colchicine and prednisolone in acute gout in primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05698680 first posted on January 26, 2023 (retrospectively registered). URL of trial registry record: https://clinicaltrials.gov/study/NCT05698680.
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Affiliation(s)
- Julia Truthmann
- Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany.
| | - Julia Freyer Martins Pereira
- Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Adrian Richter
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Franziska Schuster
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
| | - Amelie Witte
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
| | - Susanne Böhm
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
| | - Alexandra Greser
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Petra Kamin
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Sylvia Stracke
- Department of Internal Medicine, University Medical Center, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine, University Medical Center, Greifswald, Germany
| | - Robin Bülow
- Institute for Radiology and Neuroradiology, University Medical Center Greifswald, Greifswald, Germany
| | - Stefan Engeli
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
- Institute of Pharmacology, University Medical Center Greifswald, Greifswald, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
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Akiyama Y, Niimi A, Nomiya A, Taguchi S, Yamada Y, Sato Y, Yamada D, Maeda D, Ushiku T, Kume H, Homma Y. Efficacy and Safety of Low-dose Oral Prednisolone for Patients with Refractory Hunner-type Interstitial Cystitis. EUR UROL SUPPL 2023; 56:1-8. [PMID: 37822513 PMCID: PMC10562155 DOI: 10.1016/j.euros.2023.07.006] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/13/2023] Open
Abstract
Background Hunner-type interstitial cystitis (HIC) is an immunological, chronic inflammatory disease. The efficacy of corticosteroid as a treatment for HIC is unclear. Objective To assess the efficacy and safety of low-dose oral prednisolone (PSL) treatment for patients with refractory HIC. Design setting and participants This retrospective observational study reviewed the clinical outcomes of 31 patients with refractory HIC who received oral PSL daily (initial dose, 5.0 or 7.5 mg) for at least 12 mo between 2016 and 2023. The dose was tapered to the minimum that maintained symptom relief during follow-up. Outcome measurements and statistical analysis Treatment outcomes were evaluated using a seven-graded global response assessment (scores ≥+2, moderately or markedly improved, were defined as treatment response), O'Leary and Sant symptom and problem indices (OSSI/OSPI), overactive bladder symptom score (OABSS), an 11-point pain intensity numerical rating scale, a quality of life (QOL) score, and frequency-volume chart variables. Related complications were also documented. Results and limitations The mean follow-up period was 20.1 ± 14.6 mo. The overall response rates at 1, 3, 6, 9, and 12 mo at doses of 6.7, 6.7, 5.2, 4.0, and 3.0 mg were 38.7%, 48.4%, 54.8%, 61.3%, and 64.5%, respectively. Compared with baseline, OSSI/OSPI and pain intensity improved significantly from 1 mo after PSL induction. The OABSS, QOL score, urinary frequency, and voided volume improved significantly from 9 mo after PSL induction. No patients discontinued treatment due to adverse events, although hypertension and glucose intolerance occurred in two patients, but these were resolved by temporal medications. Conclusions This study showed that low-dose oral PSL significantly improves bladder pain, urinary symptoms, and QOL in patients with HIC, without serious adverse events. Further prospective evaluation is warranted to verify the potential efficacy and safety of low-dose PSL for HIC. Patient summary This retrospective observational study reviewed the clinical outcomes of 31 patients suffering from refractory Hunner-type interstitial cystitis treated with low-dose oral prednisolone. Low-dose prednisolone improved bladder pain, urinary symptoms, and quality of life significantly, without serious adverse events. The response rate of 64.5% at 12 mo was comparable with the rates reported in previous studies that used higher doses of prednisolone. This study provides a rationale for further prospective evaluation of low-dose prednisolone for this intractable disease.
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Affiliation(s)
- Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, New Tokyo Hospital, Chiba, Japan
| | - Akira Nomiya
- Department of Urology, Kanto Rosai Hospital, Kanagawa, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daichi Maeda
- Department of Molecular and Cellular Pathology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Interstitial Cystitis Medicine, Kyorin University School of Medicine, Tokyo, Japan
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Sharma S, Dabla S, Kaushik JS. Modified Atkins Diet vs. Ketogenic Diet in the Management of Children with Epileptic Spasms Refractory to First Line Treatment: An Open Labelled, Randomized Controlled Trial. Indian J Pediatr 2023; 90:969-973. [PMID: 37233891 DOI: 10.1007/s12098-023-04527-7] [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: 10/12/2022] [Accepted: 01/03/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare the efficacy and tolerability of modified Atkins diet (mAD) and ketogenic diet (KD) among children aged 9 mo to 3 y with epileptic spasms refractory to the first line treatment. METHODS An open labelled, randomized controlled trial with parallel group assignment was conducted among children aged 9 mo to 3 y with epileptic spasms refractory to the first line treatment. They were randomized to either receive the mAD along with conventional anti-seizure medications (n = 20) or KD with conventional anti-seizure medications (n = 20). Primary outcome measure was proportion of children who achieved "spasm freedom" at 4 wk and 12 wk. Secondary outcome measures were proportion of children who achieved >50% and >90% reduction in spasms at 4 wk and 12 wk, nature and proportion of the adverse effects as per parental reports. RESULTS Proportion of children achieving spasm freedom [mAD {4 (20%)} vs. KD {3 (15%)}: OR (95% CI) 1.42 (0.27-7.34); P = 0.67], >50% spasm reduction [mAD {3 (15%)} vs. KD {5 (25%)}: OR (95% CI) 0.53 (0.11-2.59); P = 0.63] and >90% spasm reduction [mAD {4 (20%)} vs. KD {2 (10%)}: OR (95% CI) 2.25 (0.36-13.97); P = 0.41] was comparable between the two groups at 12 wk. The diet was well tolerated in both the groups with vomiting and constipation being the most common reported adverse effect. CONCLUSIONS mAD is an effective alternative to KD in the management of children with epileptic spasms refractory to first line treatment. However, further studies with adequately powered sample size and longer follow-up are required. TRIAL REGISTRATION CTRI/2020/03/023791.
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Affiliation(s)
- Shobhna Sharma
- Department of Pediatrics, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Surekha Dabla
- Department of Neurology, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Jaya Shankar Kaushik
- Department of Pediatrics, All India Institute of Medical Sciences, Guwahati, Assam, 781101, India.
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Hato H, Sakata KI, Watanabe H, Sugitani A, Sato J, Asaka T, Ohga N, Kitagawa Y. Potential relationship between the dosage of prednisolone and delayed healing at tooth extraction: A retrospective study. J Dent Sci 2023; 18:1765-1770. [PMID: 37799897 PMCID: PMC10547945 DOI: 10.1016/j.jds.2022.08.021] [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: 07/31/2022] [Revised: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background/purpose Delayed healing of the extraction socket is not uncommon when tooth extraction is performed on patients taking prednisolone. This study aimed to identify specific dosage of prednisolone and factors associated with delayed healing of the extraction socket in patients taking prednisolone. Materials and methods This single-center retrospective study included 80 patients who underwent tooth extraction under local anesthesia and were taking prednisolone orally. Patients were divided into the nondelayed healing group (n = 50) and delayed healing group (n = 30), and their background and dosage of prednisolone were compared. Results The dosage of prednisolone was significantly higher in the delayed healing group than in the nondelayed healing group. A receiver operating characteristics curve analysis resulted in moderate accuracy when the cutoff value was set at 8.0, with 67% sensitivity, 76% specificity, and 0.765 area under the curve. The multivariate logistic regression analysis revealed that prednisolone dosage >8.0 mg/day (odds ratio [OR], 10.8; 95% confidence interval [CI], 2.79-41.6) and osteosclerotic changes beyond the alveolar bone around the tooth to be extracted (OR, 10.3; 95% CI, 2.81-37.8) in X-ray imaging had significant effects on delayed healing. Conclusion The results of this study suggested that delayed healing following tooth extractions in patients taking prednisolone was related to a dosage of 8.0 mg/day or higher and osteosclerotic changes.
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Affiliation(s)
- Hiroyuki Hato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Ken-ichiro Sakata
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Haruhisa Watanabe
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Ayumu Sugitani
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Jun Sato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Noritaka Ohga
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
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Atai T, Ozmaie S, Anoushepour A. Comparison of the Effects of 0.1% Fluorometholone and 1% Prednisolone on Intraocular Pressure and Schirmer Tear Test in Equine Eye. J Equine Vet Sci 2023; 128:104840. [PMID: 37348824 DOI: 10.1016/j.jevs.2023.104840] [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: 03/25/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
This research was performed to compare the effects of prednisolone and fluorometholone on intraocular pressure (IOP) and Schirmer tear test (STT) in the normal equine eye. Sixteen normal mares aged between 6 and 10 years were used for this study. Horses were randomly assigned to two groups. Eight horses in the first group received 0.2 mL of topical 1% prednisolone in one eye and the contralateral eye was used as control (0.2 mL of saline was instilled). The second group received 0.2 mL of 0.1% fluorometholone in a randomly selected eye and the contralateral eye served as control and received 0.2 mL of saline. STT values and IOP were determined using STT strips and rebound, respectively, at the baseline, and 30-, 60-, 90-, and 180-minutes post eyedrop instillation. Mean (SD) IOPs at the baseline in the treated eyes of the first and second groups were 28.5 (5.4) and 27.5 (4.9) mm Hg, respectively. STT values at the baseline in the treated eyes of the first and second groups were 26.0 (1.8) mm/min and 24.0 (4.0) mm/min, respectively. Neither prednisolone nor fluorometholone caused significant changes in the IOP during 3 hours of monitoring (P > .05). There were no significant differences in the mean levels of STT in the control and treatment eyes, either between groups or within each group (P > .05). In conclusion, one dose (0.2 mL) of 1% prednisolone or 0.1% fluorometholone after 3 hours did not alter the IOP and STT in healthy horses. Further research for a longer period on normal horses and horses with uveitis is warranted.
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Affiliation(s)
- Taraneh Atai
- Department of Clinical Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Saeed Ozmaie
- Department of Clinical Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Amin Anoushepour
- Department of Clinical Sciences, Karaj Branch, Islamic Azad University, Tehran, Iran
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Yuki M, Taira H, Narita M, Inden T, Yokota S, Naito E, Maeda S. Complete remission of two canine cases with precursor-targeted immune-mediated anemia after combination therapy with prednisolone, cyclosporine, and oclacitinib. Open Vet J 2023; 13:1205-1211. [PMID: 37842117 PMCID: PMC10576580 DOI: 10.5455/ovj.2023.v13.i9.16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/16/2023] [Indexed: 10/17/2023] Open
Abstract
Background Precursor-targeted immune-mediated anemia (PIMA) has been described in dogs presenting with nonregenerative anemia and evidence of ineffective erythropoiesis. Although it has been suggested that its occurrence may be related to the immune targeting of erythroid precursors, this pathogenesis has not been established. PIMA is mainly treated with glucocorticoids, and in cases where glucocorticoids alone are not effective, immunosuppressants are also used as combination therapy. However, not all cases of PIMA go into remission after these treatments. Case Description Two dogs with severe nonregenerative anemia diagnosed as PIMA based on the results of clinical pathological examinations, including bone marrow examination, were treated with whole-blood transfusion and immunosuppressive doses of prednisolone, mycophenolate mofetil, and cyclosporine. However, these treatments failed to achieve remission of PIMA. Therefore, concomitant administration of oclacitinib, which is a Janus kinase-1 inhibitor that has been applied recently to the treatment of immune-mediated diseases, was performed; this combined regimen improved the anemia and achieved complete remission of PIMA. Conclusion Oclacitinib may be an option for the treatment of PIMA in dogs failing to achieve remission with conventional immunosuppressive therapy.
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Affiliation(s)
- Masashi Yuki
- Yuki Animal Hospital, Minato-ku, Japan
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
| | | | | | | | - Shunya Yokota
- Yuki Animal Hospital, Minato-ku, Japan
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
| | | | - Sadatoshi Maeda
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
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Gober M, Hillier A. Perception and usage of short-term prednisone and prednisolone in dogs. BMC Vet Res 2023; 19:91. [PMID: 37488543 PMCID: PMC10364361 DOI: 10.1186/s12917-023-03644-x] [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: 10/05/2022] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Corticosteroids are widely used with low rates of reported side effects and a broad level of comfort in the hands of most veterinarians. With a low side effect reporting level of < 5% and high level of comfort there may be complacency and underestimation of the impact side effects of corticosteroids may have on a pet and pet owner. OBJECTIVE The objective of this clinical study was to describe the experience and perception of an owner who administered anti-inflammatory doses of oral prednisolone and prednisone to their dog for up to 14 days. We hypothesized dogs receiving anti-inflammatory doses of prednisone and prednisolone would experience much greater rates of side effects by day 14 then reported in current literature. ANIMALS There were 45 dogs initially enrolled in the study. RESULTS At each study point, 31 owners provided results. On day 5, 74% (23/31) reported at least 1 change in their dog's behavior including polyuria, polydipsia, polyphagia, polypnea and/or increased vocalization, with 11 individuals (35%) reporting these changes greatly increased. On day 14, 90% of owners (28/31) reported at least 1 change in their dog's behavior including polyuria, polydipsia, polyphagia, and/or polypnea as the most common changes noted. Overall, 61% (19/31) of owners reported an increase in filling of the water bowl over baseline and one-third (11/31) of pet owners reported cleaning up urinary accidents for pets who had been continent prior to the start of the study. Pet owner steroid satisfaction remained high through day 14 at 4.5/5 (1 = very unsatisfied, 5 = very satisfied). CONCLUSION This study highlights the impact short term anti-inflammatory doses of prednisone or prednisolone have on dog behaviour and confirms our hypothesis that by day 14, 90% of dogs experienced one or more behaviour changes, with polyuria and polydipsia most commonly reported. Adverse events were noted regardless of starting dosage or regimen. Although most pet owners expressed satisfaction with steroid treatment due to its high efficacy, 70% would select a more costly treatment if that treatment had fewer side effects.
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Westgate CSJ, Israelsen IME, Kamp-Jensen C, Jensen RH, Eftekhari S. Glucocorticoids modify intracranial pressure in freely moving rats. Fluids Barriers CNS 2023; 20:35. [PMID: 37231507 DOI: 10.1186/s12987-023-00439-y] [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: 03/17/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Glucocorticoids (GCs) are widely prescribed for a variety of inflammatory diseases, but they are also used to treat raised intracranial pressure (ICP) caused by trauma or oedema. However, it is unclear if GCs independently modulate ICP and if GCs are involved in normal ICP regulation. In this study, we aimed to assess the ICP modulatory effects of GCs and their molecular consequences on choroid plexus (CP). METHODS Adult female rats were implanted with telemetric ICP probes for physiological, continuous ICP recordings in a freely moving setup. Rats received prednisolone or vehicle via oral gavage in a randomized acute (24 h) ICP study. In a subsequent study rats received corticosterone or vehicle in drinking water for a 4-week chronic ICP study. CP were removed, and the expression of genes associated with cerebrospinal fluid secretion were assessed. RESULTS A single prednisolone dose reduced ICP by up to 48% (P < 0.0001), where ICP was reduced within 7 h and was maintained for at least 14 h. Prednisolone increases ICP spiking (P = 0.0075) while not altering ICP waveforms. Chronic corticosterone reduces ICP by up to 44%, where ICP was lower for the entirety of the 4-week ICP recording period (P = 0.0064). ICP daily periodicity was not altered by corticosterone. Corticosterone ICP reduction was not accompanied by ICP spike differences or alteration in ICP spike periodicity. Chronic corticosterone treatment had modest effects on CP gene expression, lowering the expression of Car2 at CP (P = 0.047). CONCLUSIONS GCs reduce ICP in both the acute and chronic setting to a similar degree. Moreover, GCs did not modify the diurnal rhythm of ICP, suggesting the diurnal variation of ICP periodicity is not under explicit control of GCs. ICP disturbances should be considered a consequence of GC therapy. Based on these experiments, GCs may have broader ICP therapeutic uses, but side effects must be taken into consideration.
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Affiliation(s)
- Connar Stanley James Westgate
- Danish Headache Center, Dept of Neurology, Rigshospitalet-Glostrup, Glostrup Research Institute, University of Copenhagen, Glostrup, Denmark
| | - Ida Marchen Egerod Israelsen
- Danish Headache Center, Dept of Neurology, Rigshospitalet-Glostrup, Glostrup Research Institute, University of Copenhagen, Glostrup, Denmark
| | - Christina Kamp-Jensen
- Danish Headache Center, Dept of Neurology, Rigshospitalet-Glostrup, Glostrup Research Institute, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Dept of Neurology, Rigshospitalet-Glostrup, Glostrup Research Institute, University of Copenhagen, Glostrup, Denmark
| | - Sajedeh Eftekhari
- Danish Headache Center, Dept of Neurology, Rigshospitalet-Glostrup, Glostrup Research Institute, University of Copenhagen, Glostrup, Denmark.
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Abbas NAT, Nafea OE, Mohammed HO, Samy W, Abdelmageed AF, Afifi R, Hassan HA. Repurposing of carvedilol to alleviate lung fibrosis in rats: Repressing of TGF-β1/α-SMA/Smad2/3 and STAT3 gene expressions. Life Sci 2023; 324:121692. [PMID: 37061127 DOI: 10.1016/j.lfs.2023.121692] [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: 01/24/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most widely studied interstitial lung disease. IPF eventually leads to respiratory insufficiency, lung cancer, and death. Carvedilol (CAR) is a third-generation β-adrenergic receptor antagonist with α1-blocking effect. CAR demonstrates antifibrotic activities in various experimental models of organ fibrosis. AIMS This work is designed to explore the possible alleviating effects of CAR on bleomycin (BLM)-induced lung fibrosis in rats. MAIN METHODS The BLM rat model of lung fibrosis was achieved by intratracheal delivery of a single dose of 5 mg/kg of BLM. Seven days following BLM injection, either prednisolone or CAR was orally administered at doses of 10 mg/kg once daily for 21 days to rats. The actions of CAR were evaluated by lung oxidant/antioxidant parameters, protein concentration and total leucocyte count (TLC) in bronchoalveolar lavage fluid (BALF), fibrosis regulator-related genes along with the coexistent lung histological changes. KEY FINDINGS CAR effectively decreased lung malondialdehyde level, increased superoxide dismutase activity, declined both protein concentration and TLC in BALF, downregulated TGF-β1/α-SMA/Smad2/3 and STAT3 gene expressions, and repaired the damaged lung tissues. SIGNIFICANCE CAR conferred therapeutic potential against BLM-induced lung fibrosis in rats, at least in part, to its antioxidant, anti-inflammatory, and antifibrotic activities. CAR could be utilized as a prospective therapeutic option in patients with lung fibrosis in clinical practice.
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Affiliation(s)
- Noha A T Abbas
- Department of Clinical Pharmacology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ola Elsayed Nafea
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; Department of Clinical Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Heba Osama Mohammed
- Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Walaa Samy
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Zagazig University, Zagazig 45519, Egypt
| | - Amal Fawzy Abdelmageed
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Zagazig University, Zagazig 45519, Egypt
| | | | - Heba A Hassan
- Department of Clinical Pharmacology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; Department of Pharmacology, Faculty of Medicine, Mutah University, P.O. Box 7, Al-Karak 61710, Jordan
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Learoyd AE, Arnold L, Reid F, Beckley-Hoelscher N, Casian A, Sangle S, Morton N, Nel L, Cape A, John S, Kim S, Shivapatham D, Luqmani R, Jayne D, Galloway J, Douiri A, D'Cruz D. The HAVEN study-hydroxychloroquine in ANCA vasculitis evaluation-a multicentre, randomised, double-blind, placebo-controlled trial: study protocol and statistical analysis plan. Trials 2023; 24:261. [PMID: 37024906 PMCID: PMC10077754 DOI: 10.1186/s13063-023-07108-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Patients with non-severe ANCA-associated vasculitis (AAV) are often prescribed immunosuppressive medications that are associated with severe side effects and a reduced quality of life. There is an unmet need for safer effective treatments for these patients. Hydroxychloroquine is being explored due to its effect in similar autoimmune conditions such as systemic lupus erythematosus. METHODS Double-blind, placebo-controlled multicentre trial recruiting 76 patients across 20 sites. Participants will be randomised 1:1 to hydroxychloroquine or placebo in addition to standard of care immunosuppressive therapies over the course of 52 weeks. A phase II selection design will be used to determine hdroxychloroquine's efficacy, using prednisolone dosage and Birmingham Vasculitis Activity Score as a measure of disease activity. Secondary outcomes will explore other elements of AAV progression, including disease flares and time to remission. DISCUSSION This trial aims to explore Hydroxychloroquine as a treatment for patients with AAV. If effective, the need for immunosuppressive treatments such as prednisolone could be reduced. Hydroxychloroquine is safer, cheaper and has fewer adverse effects than conventional immunosuppressive treatments. This could improve patient outcomes while saving money for the NHS. TRIAL REGISTRATION ISRCTN: ISRCTN79334891. Registered 07 June 2021. EudraCT: 2018-001268-40. Registered 13 September 2019. CLINICALTRIALS gov: NCT04316494. Registered 20 March 2020.
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Affiliation(s)
- Annastazia E Learoyd
- School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
| | - Lauren Arnold
- Clinical Trial Management Platform, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fiona Reid
- School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nicholas Beckley-Hoelscher
- School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Alina Casian
- Louise Coote Lupus Unit, Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shirish Sangle
- Louise Coote Lupus Unit, Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Neil Morton
- Louise Coote Lupus Unit, Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise Nel
- Louise Coote Lupus Unit, Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angela Cape
- King's Clinical Trial Unit, Research Management and Innovation Directorate, King's College London, London, UK
| | - Susan John
- Department of Immunology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Sangmi Kim
- Department of Immunology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Dharshene Shivapatham
- Clinical Trial Management Platform, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London, UK
| | - Abdel Douiri
- School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - David D'Cruz
- Louise Coote Lupus Unit, Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Jagadisan B, Dhawan A. Multidisciplinary approach and reactive immunosuppression for gene therapy related hepatotoxicity. J Hepatol 2023:S0168-8278(23)00197-6. [PMID: 36996939 DOI: 10.1016/j.jhep.2023.03.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Barath Jagadisan
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London.
| | - Anil Dhawan
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London.
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Chen AX, Radhakutty A, Zimmermann A, Stranks SN, Thompson CH, Burt MG. Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia. Diabetes Res Clin Pract 2023; 197:110557. [PMID: 36736733 DOI: 10.1016/j.diabres.2023.110557] [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: 08/31/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
AIMS The optimal treatment of prednisolone-associated hyperglycaemia is unclear, but guidelines recommend using a body weight-based daily insulin dose. This study evaluated how clinical variables were associated with insulin requirements in hospitalised patients with prednisolone-associated hyperglycaemia. METHODS In this prospective study, fifty adult inpatients who were taking prednisolone ≥20 mg/day and experienced hyperglycaemia were prescribed a 24-h intravenous insulin infusion. The daily insulin dose required to attain a mean glucose of 8 mmol/L was calculated. The associations between daily insulin dose and clinical variables were assessed. RESULTS The participants age was 69 ± 10 years, daily prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0 % (61 ± 10 mmol/mol), 77 % had known type 2 diabetes and 30 % were female. In univariate analysis, weight was associated with daily insulin dose (r2 = 0.11, p = 0.024). A multivariate model comprising sex, HbA1c, a prior diagnosis of diabetes, diabetes treatment and weight explained nearly-two thirds of the variability in daily insulin dose (r2 = 0.65, p < 0.001). CONCLUSIONS In patients with prednisolone-associated hyperglycaemia, calculating insulin doses based on sex, HbA1c, diabetes status and regular diabetes treatment and weight may improve glycaemic control compared to weight-based dosing.
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Affiliation(s)
- Angela X Chen
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Anjana Radhakutty
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia.
| | - Anthony Zimmermann
- Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia; Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, Australia.
| | - Stephen N Stranks
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Campbell H Thompson
- Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, Australia; Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia.
| | - Morton G Burt
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
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Sato H, Kimura Y, Ohba M, Ara Y, Wakabayashi S, Watanabe H. Prediction of Prednisolone Dose Correction Using Machine Learning. J Healthc Inform Res 2023; 7:84-103. [PMID: 36910914 DOI: 10.1007/s41666-023-00128-3] [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: 06/21/2022] [Revised: 11/20/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
Wrong dose, a common prescription error, can cause serious patient harm, especially in the case of high-risk drugs like oral corticosteroids. This study aims to build a machine learning model to predict dose-related prescription modifications for oral prednisolone tablets (i.e., highly imbalanced data with very few positive cases). Prescription data were obtained from the electronic medical records at a single institute. Cluster analysis classified the clinical departments into six clusters with similar patterns of prednisolone prescription. Two patterns of training datasets were created with/without preprocessing by the SMOTE method. Five ML models (SVM, KNN, GB, RF, and BRF) and logistic regression (LR) models were constructed by Python. The model was internally validated by five-fold stratified cross-validation and was validated with a 30% holdout test dataset. Eighty-two thousand five hundred fifty-three prescribing data for prednisolone tablets containing 135 dose-corrected positive cases were obtained. In the original dataset (without SMOTE), only the BRF model showed a good performance (in test dataset, ROC-AUC:0.917, recall: 0.951). In the training dataset preprocessed by SMOTE, performance was improved on all models. The highest performance models with SMOTE were SVM (in test dataset, ROC-AUC: 0.820, recall: 0.659) and BRF (ROC-AUC: 0.814, recall: 0.634). Although the prescribing data for dose-related collection are highly imbalanced, various techniques such as the following have allowed us to build high-performance prediction models: data preprocessing by SMOTE, stratified cross-validation, and BRF classifier corresponding to imbalanced data. ML is useful in complicated dose audits such as oral prednisolone. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00128-3.
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Tagliaferri A, Kania B, Patel D, Baig I, Farokhian A, Bellardini A. Hepatitis of an Unknown Etiology with Concomitant ITP. J Community Hosp Intern Med Perspect 2023; 13:67-71. [PMID: 36817307 DOI: 10.55729/2000-9666.1150] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2023] Open
Abstract
Alcoholic hepatitis (AH) usually presents after decades of alcohol consumption and can even manifest with recent abstinence. The clinical presentation may be compounded by underlying liver cirrhosis and liver function enzymes are not a reliable means of diagnosing AH due to poor sensitivity and specificity. One feature of alcoholic hepatitis is thrombocytopenia; however, patients may also have thrombocytopenia due to another underlying condition, such as Immune Thrombocytopenic Purpura (ITP). ITP is an autoimmune disease caused by autoantibodies against platelet glycoproteins. ITP is a diagnosis of exclusion and secondary causes of thrombocytopenia must be ruled out with persistent thrombocytopenia that is refractory to treatment for AH. Although there is limited data demonstrating a correlation between AH and ITP, both conditions respond to steroids. We present a case of a 42 YO M with an unknown cause of hepatitis and concomitant ITP who responded well to steroids.
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Khan F, Brady S, Kuttikat A. Challenges in the diagnosis and management of immune-mediated necrotising myopathy (IMNM) in a patient on long-term statins. Rheumatol Int 2023; 43:383-390. [PMID: 36260115 PMCID: PMC9898342 DOI: 10.1007/s00296-022-05230-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/05/2022] [Indexed: 02/06/2023]
Abstract
Immune-mediated necrotising myopathy (IMNM) is a severe and poorly understood complication of statin use. Prompt management with immunosuppressive treatment is often needed to control the condition, which differs from the management of the more commonly recognised statin-induced myopathy. We present a case report and brief review of the literature regarding the pathogenesis, diagnosis, and management of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) positive IMNM (HMGCR IMNM). There are no randomised clinical trials, but several smaller studies and cases suggest a triple therapy of corticosteroids, IVIG, and a corticosteroid-sparing immunosuppressant appears efficacious in patients with IMNM and proximal weakness. The mechanism of statin-induced IMNM is uncertain, and this is further complicated by the reports of HMGCR IMNM in statin-naïve patients, including children. We present a case of biopsy-confirmed HMGCR IMNM in a woman taking daily statins for treatment of hypercholesterolaemia for 4 years. She presented with symptoms consistent with a urinary tract infection (UTI), including muscle weakness. She was treated as an isolated case of UTI. One month later, she presented again with worsening weakness in her shoulders and hips. Creatine kinase was elevated, and MRI showed increased signal with STIR sequences in both thighs. Anti-HMGCR was positive and leg biopsy-confirmed necrotising changes. Stopping her statin prescription and a short course of prednisolone did not improve her muscle weakness. Adding methotrexate resulted in eventual resolution of her symptoms. IMNM should be considered as a differential in any patient taking statins presenting with muscle weakness, and this case suggests that immunosuppressant therapy in addition to cessation of statins is effective at treating IMNM. Clinical trials are needed to further investigate the efficacy of different combinations of immunosuppressants.
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Affiliation(s)
- Faris Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
| | - Stefen Brady
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Anoop Kuttikat
- Kettering General Hospital, Kettering, NN16 8UZ, UK.,Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
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Ahmadi L, Eskandari N, Ghanadian M, Rahmati M, Kasiri N, Etamadifar M, Toghyani M, Alsahebfosoul F. The Immunomodulatory Aspect of Quercetin Penta Acetate on Th17 Cells Proliferation and Gene Expression in Multiple Sclerosis. Cell J 2023; 25:110-117. [PMID: 36840457 PMCID: PMC9968368 DOI: 10.22074/cellj.2022.557560.1073] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 02/26/2023]
Abstract
OBJECTIVE The function of Th17 cells in the neuroinflammatory process in multiple sclerosis (MS) has been previously clarified. It has been suggested that Quercetin can influence MS due to a variety of anti-inflammatory effects. The present study aimed to examine in vitro immunomodulatory aspects of Quercetin Penta Acetate as a modified compound on Th17 cells of MS patients and also to compare its effects with Quercetin. MATERIALS AND METHODS In this experimental study, peripheral blood mononuclear cell (PBMCs) were isolated and stained with CFSE then, half-maximal inhibitory concentration (IC50) values were determined using different doses and times for Quercetin Penta Acetate, and Methyl Prednisolone Acetate. Th17 cell proliferation was analyzed by flow cytometry and the expression levels of IL-17 and RORc genes were assessed by real-time polymerase chain reaction (PCR) method. RESULTS The results showed that IL-17 gene expression was inhibited by Quercetin Penta Acetate (P=0.0081), but Quercetin Penta Acetate did not have a significant inhibitory effect on Th17 cells proliferation (P= 0.59) and RORc gene expression (P=0.1), compared to Quercetin. CONCLUSION Taken together, our results showed some immunomodulatory aspects of Quercetin Penta Acetate on Th17 cells are more effective than Quercetin and it could be considered in the treatment of MS.
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Affiliation(s)
- Leila Ahmadi
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Eskandari
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,P.O.Box: 8174673461Department of ImmunologyFaculty of MedicineIsfahan University of Medical SciencesIsfahanIran
Emails:, Institute
| | - Mustafa Ghanadian
- Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahshid Rahmati
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Kasiri
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Etamadifar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Iranian Multiple Sclerosis and Neuroimmunology Research Center, Isfahan, Iran
| | - Mohadeseh Toghyani
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Alsahebfosoul
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Iranian Multiple Sclerosis and Neuroimmunology Research Center, Isfahan, Iran,P.O.Box: 8174673461Department of ImmunologyFaculty of MedicineIsfahan University of Medical SciencesIsfahanIran
Emails:, Institute
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Senda M, Ueda A, Ito M, Shima S, Mizutani Y, Mutoh T, Watanabe H. Long-term response to immunotherapy in patients with hypertrophic pachymeningitis. Fujita Med J 2023; 9:35-40. [PMID: 36789128 PMCID: PMC9923450 DOI: 10.20407/fmj.2021-026] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/05/2022] [Indexed: 02/16/2023]
Abstract
Objective In this study, we aimed to clarify the relationship between initial treatment response, prednisolone (PSL) dosage, clinical type, and recurrence in patients with hypertrophic pachymeningitis (HP). Methods The study cohort comprised eight patients with HP who had been admitted to our hospital from April 2015 to June 2020. Diagnostic criteria for HP included neurological abnormalities and dural thickening on magnetic resonance gadolinium-enhanced T1-weighted images. Results Relevant characteristics of the eight study patients are as follows. There were two men and six women. The average age at onset was 58.3 (range: 29-79) years. Three of them had myeloperoxidase-antineutrophil cytoplasmic antibody-related vasculitis, one immunoglobulin G4-related disease, and one ulcerative colitis. The remaining three patients had idiopathic HP. The average maximum dosage of PSL was 0.79 mg/kg/day, and the average daily maintenance dosage 0.18 mg/kg/day. Three patients needed additional immunosuppressive drugs. Both idiopathic and secondary HP initially responded well to PSL, with improvement in activities of daily living. Six patients had some sequelae related to cranial nerve involvement. No relapses occurred while the patients were taking moderate doses of PSL; however, all patients with idiopathic HP had recurrences when their PSL dosage was reduced. Conclusions Patients with idiopathic HP and HP associated with immune disorders respond to steroids and immunosuppressive drugs and recover well. However, there is a high rate of relapse after reduction of PSL dosage, mainly in those with idiopathic HP.
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Affiliation(s)
- Mayumi Senda
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan,Department of Neurology, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Akihiro Ueda
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Mizuki Ito
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan,Department of Neurology, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Sayuri Shima
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yasuaki Mizutani
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tatsuro Mutoh
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
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Korelc K, Larsen BS, Gašperlin M, Tho I. Water-soluble chitosan eases development of mucoadhesive buccal films and wafers for children. Int J Pharm 2023; 631:122544. [PMID: 36572261 DOI: 10.1016/j.ijpharm.2022.122544] [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: 09/20/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
Oromucosal films and wafers are user-friendly solid dosage forms offering easy and convenient administration, as well as rapid or controlled drug delivery. The aim of this study was to develop prednisolone containing child-friendly chitosan-based mucoadhesive films and wafers with a prolonged residence time on the buccal mucosa. Four different chitosan types (different molecular weights, degree of deacetylation (DDA), pattern of deacetylation) were studied for films prepared by solvent-cast-evaporation and wafers by freeze-drying. Mucoadhesive properties correlated with swelling abilities and were dependent on the chitosan type, the solvent, and the preparation method. Mucoadhesive forces were higher for formulations containing chitosan with higher DDA and for wafers compared to films. The drug release was relatively fast, especially for films (approx. 90 % in 15 minutes) and steadier for wafers (90 % in 45-120 minutes). Permeability was evaluated using artificial membranes and HT29-MTX cell-monolayers. The developed formulations exhibited good biocompatibility. Organoleptic properties can be improved by choosing a homogenously deacetylated chitosan type that provides a more neutral pH. Using hydroxypropyl-beta-cyclodextrin-complexation for taste masking of bitter drugs also reduced wafers' drug release rate. Mucoadhesive wafers are promising alternatives to films with a slower drug release rate and stronger mucoadhesion.
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Affiliation(s)
- Karin Korelc
- Department of Pharmacy, University of Oslo, P.O.Box 1068 Blindern, 0316 Oslo, Norway.
| | - Bjarke Strøm Larsen
- Department of Pharmacy, University of Oslo, P.O.Box 1068 Blindern, 0316 Oslo, Norway
| | - Mirjana Gašperlin
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva cesta 7, 1000 Ljubljana, Slovenia
| | - Ingunn Tho
- Department of Pharmacy, University of Oslo, P.O.Box 1068 Blindern, 0316 Oslo, Norway
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Badurdeen Z, Ratnatunga N, Abeysekera T, Wazil AWM, Rajakrishna PN, Thinnarachchi JP, Welagedera DD, Ratnayake N, Alwis APD, Abeysundara H, Kumarasiri R, Taylor R, Nanayakkara N. Randomized control trial of prednisolone and doxycycline in patients with acute interstitial nephritis of unknown aetiology. Trials 2023; 24:11. [PMID: 36600250 DOI: 10.1186/s13063-022-07056-4] [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: 11/28/2021] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients presenting with acute interstitial nephritis (AIN) of unknown aetiology, probably the earliest presentation of chronic kidney disease of unknown aetiology (CKDu), have been treated with oral prednisolone and doxycycline by physicians in Sri Lanka. This trial assessed the effectiveness of prednisolone and doxycycline based on eGFR changes at 6 months in patients with AIN of unknown aetiology. METHOD A randomized clinical trial with a 2 × 2 factorial design for patients presenting with AIN of unknown aetiology (n = 59) was enacted to compare treatments with; A-prednisolone, B-doxycycline, C-both treatments together, and D-neither. The primary outcome was a recovery of patients' presenting renal function to eGFR categories: 61-90 ml/min/1.73m2 (complete remission- CR) to 31-60 ml/min/1.73m2 (partial remission- PR) and 0-30 ml/min/1.73m2 no remission (NR) by 6 months. A secondary outcome was progression-free survival (not reaching < 30 ml/min/1.73m2 eGFR), by 6-36 months. Analysis was by intention to treat. RESULTS Seventy patients compatible with a clinical diagnosis of AIN were biopsied for eligibility; 59 AIN of unknown aetiology were enrolled, A = 15, B = 15, C = 14 and D = 15 randomly allocated to each group. Baseline characteristics were similar between groups. The number of patients with CR, PR and NR, respectively, by 6 months, in group A 3:8:2, group B 2:8:3 and group C 8:5:0 was compared with group D 8:6:1. There were no significant differences found between groups A vs. D (p = 0.2), B vs. D (p = 0.1) and C vs. D (p = 0.4). In an exploratory analysis, progression-free survival in prednisolone-treated (A + C) arms was 0/29 (100%) in comparison to 25/30 (83%) in those not so treated (B + D) arms, and the log-rank test was p = 0.02, whereas no such difference found (p = 0.60) between doxycycline-treated (B + C) arms 27/29 (93%) vs those not so treated (A + D) arms 27/30 (90%). CONCLUSION Prednisolone and doxycycline were not beneficial for the earliest presentation of CKDu at 6 months. However, there is a potential benefit of prednisolone on the long-term outcome of CKDu. An adequately powered steroid trial using patients reaching < 30 ml/min/1.73m2 eGFR by 3 years, as an outcome is warranted for AIN of unknown aetiology. TRIAL REGISTRATION Sri Lanka Clinical Trial Registry SLCTR/2014/007, Registered on the 31st of March 2014.
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Affiliation(s)
- Zeid Badurdeen
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Tilak Abeysekera
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | - Abdul W M Wazil
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | | | | | - Nadeeka Ratnayake
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | - Hemalika Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Richard Taylor
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine, University of New South Wales (UNSW), Kensington, Australia
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Li Z, Denning DW. The Impact of Corticosteroids on the Outcome of Fungal Disease: a Systematic Review and Meta-analysis. Curr Fungal Infect Rep 2023; 17:54-70. [PMID: 36852004 DOI: 10.1007/s12281-023-00456-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/25/2023]
Abstract
Purpose of Review Corticosteroids have a complex relationship with fungal disease - risk for many, benefit for others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome in different fungal diseases. Recent Findings Corticosteroids are a risk factor of aspergillosis for patients who have COVID-19, and they also led to a worse outcome. Similarity, corticosteroids are a risk factor for candidemia and mucormycosis. Some researchers reported that using topical corticosteroid in keratitis was associated with worse visual outcome if fungal keratitis. Some studies showed that corticosteroids are linked to a negative outcome for non-HIV patients with Pneumocystis jirovecii pneumonia (PCP), in contrast to those with HIV and PCP. Summary In 59 references, we found that corticosteroid therapy showed a worse clinical outcome in invasive aspergillosis (IA) (HR: 2.50, 95%CI: 1.89-3.31, p < 0.001) and chronic pulmonary aspergillosis (CPA) (HR: 2.74, 95%CI: 1.48-5.06, p = 0.001), PCP without HIV infection (OR: 1.29, 95%CI: 1.09-1.53, p = 0.003), invasive candidiasis and candidaemia (OR: 2.13, 95%CI: 1.85-2.46, p < 0.001), mucormycosis (OR: 4.19, 95%CI: 1.74-10.05, p = 0.001) and early in the course of fungal keratitis (OR: 2.99, 95%CI: 1.14-7.84, p = 0.026). There was equivocal outcome in cryptococcal meningoencephalitis in AIDS and primary coccidioidomycosis, while corticosteroid therapy showed a better outcome in PCP in HIV-infected patients (RR: 0.62, 95%CI: 0.46-0.83, p=0.001) and fungal keratitis patients after keratoplasty surgery (OR: 0.01, 95%CI: 0.00-0.41, p = 0.041) and probably in cryptococcal meningoencephalitis in non-immunocompromised patients. A sub-analysis in invasive aspergillosis and CPA showed that use of more than 2 mg/kg/day of prednisolone equivalents per day is a significant factor in increasing mortality (HR: 2.94, 95%CI: 2.13-4.05, p < 0.001). Corticosteroid therapy during invasive fungal disease was usually associated with a slightly or greatly increased mortality or worse visual outcome (in fungal keratitis), with two disease exceptions. Avoiding the addition of corticosteroids, or minimising dose and duration in those who require them, is likely to improve the outcome of most life- and vision-threatening fungal diseases. This review provides a cornerstone for further research in exploring the accuracy of suitable dose and duration of corticosteroids treatment in fungal diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s12281-023-00456-2.
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Asl MS, Motakef Z, Behgam N, Attaran S, Mirsadraee M. Comparison of Longevity in Patients with Idiopathic Pulmonary Fibrosis Using Pirfenidone Versus Triple Therapy with Prednisolone, Azathioprine, and Acetylcysteine. Tanaffos 2023; 22:129-135. [PMID: 37920315 PMCID: PMC10618587] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2023]
Abstract
Background The effect of the combination of prednisolone, azathioprine, and acetylcysteine for the treatment of Idiopathic pulmonary fibrosis (IPF) is minimal. We aimed to investigate the effect of these drugs in case of intolerance to new anti-fibrotic drugs. Materials and Methods This historical prospective study was performed on 91 patients with idiopathic pulmonary fibrosis who were referred to a pulmonologist in Mashhad during 2016-2020. Patients were divided into two groups, Pirfenidone which was prescribed for 46 subjects, and a combination of prednisolone, azathioprine, and acetylcysteine which was prescribed for 45 subjects. Patients were selected by convenience sampling and a life expectancy comparison between the two groups was performed by Cox regression. Results There were no statistically significant differences between age, gender, and drug type in the two groups at the beginning of treatment. The death rate per year in the triple-drug treatment group was 44.44% (n = 20) and in the Pirfenidone treatment group was 11.08% (n=2). Of the 65 recovered population, 49% (22 patients) were in the triple-drug treatment group, and 78% (36 patients) were in the Pirfenidone treatment group which indicated that Pirfenidone has a significant impact on reducing death rate compared to triple-drug treatment (pvalue=0.003 <0.05). Pirfenidone decreased the risk of death, compared to triple therapy (0.23 when death was set up as one in the triple-therapy group). Conclusion Pirfenidone has a favorable effect on increasing life expectancy and triple therapy should be considered as short-term only in subjects intolerant to anti-fibrotic.
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Affiliation(s)
| | - Zahra Motakef
- Student Research Committee, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Nazgol Behgam
- Student Research Committee, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | | | - Majid Mirsadraee
- Department of Internal Medicine, Islamic Azad University of Mashhad Branch, Mashhad, Iran
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Osborne JP, Edwards SW, Alber FD, Hancock E, Johnson AL, Kennedy CR, Likeman M, Lux AL, Mackay M, Mallick A, Newton RW, Nolan M, Pressler R, Rating D, Schmitt B, Verity CM, O'Callaghan FK. Prednisolone or tetracosactide depot for infantile epileptic spasms syndrome? A prospective analysis of data embedded within two randomised controlled trials. Eur J Paediatr Neurol 2023; 42:110-116. [PMID: 36621063 DOI: 10.1016/j.ejpn.2022.12.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To report a prospectively planned analysis of two randomised controlled trials with embedded comparisons of prednisolone versus tetracosactide depot for the treatment of infantile epileptic spasms syndrome (IESS). METHODS Individual patient data from patients randomly allocated to prednisolone or tetracosactide depot were analysed from two trials (UKISS, ICISS). The comparison was embedded within trials in which some patients also received vigabatrin but only patients receiving monotherapy with randomly allocated hormonal treatments are included in this analysis. The main outcome was cessation of spasms (Days 13-14 after randomisation). Lead time to treatment and underlying aetiology were taken into account. Cessation of spasms on Days 14-42 inclusive, electroclinical response (EEG Day 14), plus developmental and epilepsy outcomes (at 14 months in UKISS and 18 months in ICISS) are also reported. Minimum treatment was prednisolone 40 mg per day for two weeks or tetracosactide depot 0·5 mg IM on alternate days for two weeks, all followed by a reducing dose of prednisolone over two weeks. RESULTS 126 infants were included in this study. On tetracosactide depot, 47 of 62 (76%) were free of spasms on Days 13-14 compared to 43 of 64 (67%) on prednisolone (difference 9%, 95% CI -7·2% to +25·2%, chi square 1·15, p = 0·28). For Day 14-42 cessation of spasms, on tetracosactide depot, 41 of 61 (67%) were free of spasms compared to 35 of 62 (56%) on prednisolone (difference 11%, 95% CI -6·4% to +28·4%, chi square 1·51, p = 0·22). There was no significant difference in mean VABS score between infants who received prednisolone compared with those who received tetracosactide depot (74·8 (SD 18·3) versus 78·0 (SD 20·2) t = -0·91 p = 0·36). The proportion with ongoing epilepsy at the time of developmental assessment was 20 of 61 (33%) in the tetracosactide group compared with 26 out of 63 (41%) in the prednisolone group (difference 8%, 95% CI -9·2% to +25·2%, Chi [2] 0·95, p = 0·33). SIGNIFICANCE With hormone monotherapy, either prednisolone or tetracosactide depot may be recommended for infantile epileptic spasms syndrome.
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Affiliation(s)
- John P Osborne
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK; Children's Department, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK
| | - Stuart W Edwards
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK; Children's Department, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK
| | - Fabienne Dietrich Alber
- Division of Neurology/Neuropsychology, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Eleanor Hancock
- Children's Department, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK
| | - Anthony L Johnson
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials Methodology, 90, High Holborn, London, WC1V 6LJ, UK
| | - Colin R Kennedy
- Clinical Neurosciences, Faculty of Medicine, University of Southampton. Mailpoint 803 G, Southampton General Hospital, Southampton, SO16 6YB, UK
| | - Marcus Likeman
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS3 8AE, UK
| | - Andrew L Lux
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS3 8AE, UK
| | - Mark Mackay
- Neurology Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3058, Australia
| | - Andrew Mallick
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS3 8AE, UK
| | - Richard W Newton
- Department of Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, M13 9WL, UK
| | - Melinda Nolan
- Starship Children's Health, Private bag 92024, Auckland, 1142, New Zealand
| | - Ronit Pressler
- UCL Institute of Child Health, Clinical Neurosciences, London, WC1N 1EH, UK
| | | | - Bernhard Schmitt
- Division of Paediatric Neurology, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | | | - FinbarJ K O'Callaghan
- Head of Clinical Neurosciences Section, Room 41, 4th Floor PUW South, Institute of Child Health, University College London, London, WC1N 1EH, UK.
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Kambara Y, Fujii N, Usui Y, Yamamoto A, Higo H, Fujiwara H, Asada N, Ennishi D, Nishimori H, Fujii K, Matsuoka KI, Maeda Y. Association between early corticosteroid administration and long-term survival in non-infectious pulmonary complications after allogeneic hematopoietic stem cell transplantation. Int J Hematol 2022;:1-12. [PMID: 36564623 DOI: 10.1007/s12185-022-03517-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Non-infectious pulmonary complications (NIPCs) after allogeneic hematopoietic stem cell transplantation (HSCT) are associated with poor outcomes. It is important to maximize the effectiveness of primary treatment because secondary treatment has not been established. We analyzed data from 393 patients who underwent allogeneic HSCT during a 10-year period. Thirty-seven were diagnosed with NIPCs, which consisted of idiopathic pneumonia syndrome, bronchiolitis obliterans, and interstitial lung disease including cryptogenic organizing pneumonia. Among these, 18 died (Dead group) while 19 remained alive (Alive group) during the study period. The median time between NIPC diagnosis and first administration of ≥ 1 mg/kg/day corticosteroids (prednisolone dose equivalent) was significantly longer in the Dead group than the Alive group, at 9 days versus 4 days (p = 0.01). We further divided these cases into those who received prednisolone within seven days and after 8 days. We found that the ≤ 7 days group were more likely to survive after their NIPC diagnosis compared to the ≥ 8 days group (p = 0.06). Our analysis showed that early initiation of corticosteroid therapy is associated with long-term survival in NIPCs.
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Sakpichaisakul K, Boonkrongsak R, Lertbutsayanukul P, Iemwimangsa N, Klumsathian S, Panthan B, Trachoo O. Epileptic spasms related to neuronal differentiation factor 2 (NEUROD2) mutation respond to combined vigabatrin and high dose prednisolone therapy. BMC Neurol 2022; 22:461. [PMID: 36494631 PMCID: PMC9733267 DOI: 10.1186/s12883-022-02992-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epileptic spasms are a devastating form of early infantile epileptic encephalopathy (EIEE) with various etiologies. Early diagnosis and a shorter lead time to treatment are crucial to stop the seizures and optimize the neurodevelopmental outcome. Genetic testing has become an integral part of epilepsy care that directly guides management and family planning and discovers new targeted treatments. Neuronal differentiation Factor 2 (NEUROD2) variants have recently been a cause of neurodevelopmental disorders (NDDs) and EIEEs with distinctive features. However, there is limited information about the clinical and electroencephalographic response of epileptic spasm treatment in NEUROD2-related NDD syndrome. CASE PRESENTATION We report a female patient of Southeast Asian ethnicity with global developmental delay and epileptic spasms commencing in the first few months of life. A novel de novo heterozygous pathogenic NEUROD2 variant, p. E130Q, was subsequently identified by whole-exome sequencing. Electroencephalogram before treatment showed multifocal independent spikes predominantly in both posterior head regions and demonstrated marked improvement following combined vigabatrin and high-dose prednisolone treatment. However, multiple courses of relapse occurred after weaning off the antiseizure medication. CONCLUSIONS We propose that epileptic spasms related to de novo NEUROD2 pathogenic variant respond well to combined vigabatrin and high-dose prednisolone therapy. These findings may imply the benefit of using combination therapy to treat epileptic spasms in NEUROD2-related NDD syndrome.
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Affiliation(s)
- Kullasate Sakpichaisakul
- grid.415584.90000 0004 0576 1386Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, 10400 Thailand
| | - Rachata Boonkrongsak
- grid.415584.90000 0004 0576 1386Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, 10400 Thailand
| | | | - Nareenart Iemwimangsa
- grid.10223.320000 0004 1937 0490Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Sommon Klumsathian
- grid.10223.320000 0004 1937 0490Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | | | - Objoon Trachoo
- grid.10223.320000 0004 1937 0490Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand ,grid.10223.320000 0004 1937 0490Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok, 10400 Thailand
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