Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids

PURPOSE

We sought to investigate the risk of cataract development among patients with juvenile idiopathic arthritis (JIA)-associated uveitis treated with topical corticosteroids.

DESIGN

Retrospective cohort study.

PARTICIPANTS

We included 75 patients with JIA-associated uveitis observed from July 1984 through August 2005 at a single academic center.

METHODS

Clinical data on these patients were collected by chart review and were analyzed.

MAIN OUTCOME MEASURES

Incidence of new-onset cataract. Risk factors for cataract development were assessed with attention paid to the use of topical corticosteroids.

RESULTS

Over a median follow-up of 4 years, the incidence of new-onset cataract was 0.04/eye-year (EY; 95% confidence interval [CI], 0.02-0.09). Of the 60 eyes in 40 patients who received topical corticosteroid therapy, there was a dose-dependent increase in the rate of cataract development among eyes receiving topical corticosteroids. The incidence of cataract was 0.01/EY for eyes treated with < or = 3 drops daily and 0.16/EY (P = 0.0006 for log-rank test) for eyes treated with >3 drops daily. Among eyes receiving < or = 2 drops daily, the incidence of cataract was 0/EY (95% CI [1 sided], 0.03/EY). Presence of posterior synechiae, active uveitis, and use of topical corticosteroids at presentation were significantly associated with cataract development after controlling for confounding variables. Use of topical corticosteroids was associated with cataract formation independent of uveitis activity. Using longitudinal data analysis and controlling for duration of uveitis, presence and degree of active uveitis, and concomitant use of other forms of corticosteroids in a time-updated fashion, treatment with < or = 3 drops daily of topical corticosteroid was associated with an 87% lower risk of cataract formation compared with eyes treated with >3 drops daily (relative risk, 0.13; 95% CI, 0.02-0.69; P = 0.02).

CONCLUSIONS

In our cohort, topical corticosteroid use was associated with an increased risk of cataract formation independent of active uveitis or presence of posterior synechiae. However, chronic use of topical corticosteroids dosed at < or = 3 drops daily seemed to be associated with a lower risk of cataract development relative to eyes receiving higher doses over follow-up in the setting of suppressed uveitis.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Comparison of prednisolone 1%, rimexolone 1% and ketorolac tromethamine 0.5% after cataract extraction

PURPOSE

To compare the efficacy, safety and patient comfort of two topical steroids (prednisolone 1% and rimexolone 1%) and a topical non-steroidal anti-inflammatory agent (ketorolac tromethamine 0.5%) after extracapsular cataract extraction.

METHODS

Forty-five patients were enrolled in this prospective, randomized, double-blind study. They were assigned to receive topical treatment with either prednisolone, rimexolone or ketorolac tromethamine ophthalmic solution after phacoemulsification for cataract extraction. On postoperative days 1, 3, 5, 14 and 28 best-corrected visual acuity, intraocular pressure (IOP), slit-lamp examination of the anterior segment and report of the patients' comfort were assessed and compared by Friedman rank time analysis.

RESULTS

Regarding the primary outcome efficacy of inflammation control the assessment of cells did not differ (p=0.165), while flare in the anterior chamber was lowest (p=0.008) in the non-steroidal anti-inflammatory drug (NSAID) group. Surface inflammation was lowest with prednisolone (p=0.002). Regarding safety, visual acuity did not differ among the groups. In the prednisolone group one patient, however, responded to steroid treatment with elevated IOP and had to be excluded. In the remaining patients IOP was even lower in the two steroidal treatment groups than with ketorolac (p=0.030). One patient receiving ketorolac had to be excluded because a corneal erosion developed. Patient comfort was highest with prednisolone (p=0.041).

CONCLUSIONS

Ketorolac tromethamine provides good control of intraocular inflammation after cataract extraction without the risk of a steroidal IOP increase, which was also not observed under rimexolone therapy. The best surface inflammation control and patient comfort was observed with prednisolone, which remains a good choice.

Efficacy and safety of 1% rimexolone versus 1% prednisolone acetate in the treatment of anterior uveitis ? a randomized triple masked study

PURPOSE

To evaluate the efficacy and safety of 1% rimexolone versus 1% prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis.

METHODS

A randomised triple masked, parallel comparison of rimexolone and prednisolone acetate ophthalmic suspensions was carried out on 78 patients with acute, chronic and recurrent anterior uveitis. Treatment regimen included instillation of one or two drops of drug one hourly through the waking hours during the first week, two hourly in the second week, four times a day in the third week, two times a day for the first 4 days and once a day for the 3 days in the last week. The patient was clinically evaluated on the 3-4th, 7-10th, 14th, 21st and 28th days. The patient was also reviewed on the 30th day. Anterior chamber cells and flare reactions were compared for evaluating the efficacy of the drugs.

RESULT

Rimexolone is as effective as prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis. The largest difference found was 0.1 in the flare reaction (statistically insignificant; p = 0.3) and 0.2 score units (statistically significant; p = 0.01) in the cells. Overall, comparison of the drugs shows no clinical significance in the treatment of anterior uveitis by either drug. Difference in intraocular pressure (IOP) was also statistically insignificant (p > 0.05). However, three patients in the prednisolone acetate group and 1 patient from the rimexolone group showed a rise in IOP.

CONCLUSION

Rimexolone 1% ophthalmic suspension is as effective as and safer than prednisolone acetate 1% ophthalmic suspension in the treatment of anterior uveitis.

Ocular-Hypertensive and Anti-inflammatory Response to Rimexolone Therapy in Children

OBJECTIVE

To compare the ocular-hypertensive and anti-inflammatory response to rimexolone (116-hydroxy-16alphafluoro-6alphamethylpresdnisolone) and fluorometholone (21-deoxy-9alphafluoro-6alphamethylprednisolone) therapy in children's eyes.

METHODS

With parental consent, children who underwent surgical procedures for bilateral symmetric strabismus from January 18, 2000, through November 16, 2001, were recruited. One eye was randomized to receive topical 1% rimexolone while the contralateral eye received topical 0.1% fluorometholone, 4 times daily for 4 weeks.

MAIN OUTCOME MEASURES

Intraocular pressures and anti-inflammatory responses were the main outcome measures and were serially measured postoperatively for 8 weeks.

RESULTS

Fifty-four children, aged from 4 to 8 years (mean [SD] age, 5.33 [1.26] years), participated in the study. Intraocular pressure increased significantly in both treatment groups compared with the preoperative values (P<.001). The mean (SD) peak intraocular pressure was significantly higher in the rimexolone-treated group, 19.7 (6.1) vs 17.6 (4.6) mm Hg (P<.001). Similarly, the mean (SD) net increase in intraocular pressure (P<.001), was also higher in the rimexolone-treated eyes, 5.9 (4.4) vs 3.9 (4.1) mm Hg (P<.001). In addition, a greater percentage of the rimexolone-treated patients had no conjunctival erythema on days 13 (11.1% vs 0.0%) and 20 (88.9% vs 55.6%) (P =.03).

CONCLUSIONS

Rimexolone seems to be a more effective anti-inflammatory agent than fluorometholone. However, unlike adults, the ocular-hypertensive effect in children treated with rimexolone was higher. It would be desirable to monitor the intraocular pressure regularly when rimexolone therapy is used in children.

Lipomatosis due to chronic steroid therapy

(1) Lipomatosis (development of non encapsulated fatty masses) is a rare complication of chronic systemic steroid therapy. (2) Epidural and mediastinal lipomatosis due to steroid therapy carries a risk of symptomatic compression. (3) A dose reduction or, if possible, cessation of systemic steroid therapy almost always improves or removes the symptoms.

Pharmacological validation of a feline model of steroid-induced ocular hypertension

OBJECTIVE

To validate pharmacologically the feline model of steroid-induced ocular hypertension.

METHODS

Serial studies were conducted in domesticated adult female cats trained to accept topical ocular drug administration and pneumotonometry. To establish intraocular pressure (IOP) values for each study, measurements were performed at the same time of day for 6 consecutive days. Beginning on day 7, cats received either steroid or vehicle administered topically to both eyes three times a day for approximately 28 days. The IOP measurements were performed daily.

RESULTS

After 5 to 7 days of treatment with 0.1% dexamethasone or 1.0% prednisolone acetate, IOP began to increase, reaching peak values within 2 weeks. These values were sustained throughout dosing but declined rapidly to baseline upon cessation of treatment. Maximum IOPs for the dexamethasone- and prednisolone-treated groups averaged 4.5 +/- 0.3 mm Hg (n = 12) greater than the mean IOP value obtained in vehicle-treated cats. Cats treated with 0.25% fluorometholone, 1.0% loteprednol etabonate, and 1.0% rimexolone exhibited increases of 0.6, 1.2, and 1.7 mm Hg, respectively. These values were significantly lower than those observed following treatment with dexamethasone or prednisolone.

CONCLUSIONS

The ocular hypertensive effects of selected anti-inflammatory topical ocular steroids in this model are consistent with clinical findings.

CLINICAL RELEVANCE

This feline model is a useful tool for assessing the potential IOP liability of novel anti-inflammatory steroids.

A pharmacoeconomic analysis of rimexolone for the treatment of ophthalmic inflammatory conditions

Topical steroids are the standard first-line therapy for treating ophthalmic inflammatory conditions. However, potent ophthalmic steroids can lead to an elevation of intraocular pressure (IOP), which can result in greater medical resource utilization and increased costs. We have developed a decision analysis model from a societal perspective to evaluate the costs and consequences of the treatment of ophthalmic inflammatory conditions with two potent topical steroids: prednisolone and rimexolone. Data for the model are based on information from clinical trials, national data-bases, published literature, and responses by ophthalmologists to a questionnaire on treatment patterns for elevated IOP. Three steroid-responsive conditions are examined separately with the model: uveitis; postoperative inflammation following cataract surgery; and other ophthalmic inflammatory conditions (blepharitis, episcleritis, postoperative refractive surgery, and corneal transplant). The model evaluates patients with acute conditions versus those with chronic conditions and those with mild to moderate elevation of IOP versus those with severe elevation of IOP. Although the unit cost of rimexolone is higher than that of prednisolone, use of rimexolone leads to cost savings because the incidence of elevated IOP is decreased. If rimexolone is used instead of prednisolone for the treatment of ophthalmic inflammatory conditions, the estimated cost saved (at 1995 AWP prices) is approximately $10 million across the entire US population. The savings across the health maintenance organization population on an annualized basis is approximately $3.9 million. Even if rimexolone were priced higher than current market charges (at 130% to 150% of the AWP of prednisolone), cost savings ranging from the $2.9 million to $720,000 would accrue with use of rimexolone compared with prednisolone. However if, rimexolone were priced at 160% of the AWP of prednisolone, its use would incur an additional cost of $300,000. The primary medical resource utilized in treating elevated IOP in ophthalmic inflammatory conditions is physician visits. Medications are responsible for only one-fifth to one-third of the total cost of treating elevated IOP. This analysis indicates that rimexolone is associated with decreased medical resource utilization and cost savings to the entire healthcare system.

Control of ocular inflammation after cataract extraction with rimexolone 1% ophthalmic suspension

PURPOSE

To assess the efficacy and safety of rimexolone 1% ophthalmic suspension in controlling intraocular inflammation after cataract extraction.

SETTING

Twelve independent investigational centers in the United States

METHODS

This study comprised 197 patients who had cataract extraction. Postoperatively, patients were randomized to a 2 week regimen of rimexolone 1% ophthalmic suspension or a placebo. Efficacy was analyzed by monitoring total anterior chamber cells and flare, other parameters of inflammation, and treatment failures. Safety was evaluated by monitoring treatment-related adverse events and intraocular pressure (IOP).

RESULTS

Rimexolone 1% was clinically and statistically more effective in suppressing cell and flare than the placebo (P < .02). The overall discontinuation rate for treatment-related adverse events was 5.3% in the rimexolone group and 22.2% in the placebo group. There were no between-group differences in IOP.

CONCLUSION

Rimexolone 1% ophthalmic suspension was safe and significantly more effective than a placebo in controlling intraocular inflammation after cataract extraction when used four times daily and continued for 2 weeks.

Intraocular pressure-raising potential of 1.0% rimexolone in patients responding to corticosteroids

OBJECTIVE

To compare the intraocular pressure (IOP) elevating potential of 1.0% rimexolone and 0.1% fluorometholone alcohol ophthalmic suspensions in patients known to have responded to corticosteroids.

DESIGN

In a double-masked, randomized, single-eye, crossover protocol, corticosteroid responsiveness initially was verified in 40 asymptomatic known steroid responders by challenge with either 0.1% dexamethasone sodium phosphate or 1.0% prednisolone acetate for up to 6 weeks. After a 1-month medication washout, subjects randomly received either rimexolone or fluorometholone for 6 weeks. Medications were again discontinued for 1 month, and subjects then received the alternate drug for 6 weeks.

RESULTS

There was no significant difference between rimexolone and fluorometholone in the number of subjects demonstrating a 10-mm Hg increase in IOP or in the mean number of weeks required to achieve a 10-mm Hg response. Responses occurred in significantly more subjects receiving dexamethasone sodium phosphate (P = .001) or prednisolone acetate (P < .001) and in a significantly shorter interval than in subjects receiving rimexolone.

CONCLUSIONS

Rimexolone has a low IOP-elevating potential, comparable to that of fluorometholone and less than that of dexamethasone sodium phosphate and prednisolone acetate.

Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis

PURPOSE

Two multicenter studies compared the efficacy and safety of rimexolone 1% ophthalmic suspension (Vexol 1%, Alcon) and 1% prednisolone acetate (Pred Forte, Allergan).

METHODS

Patients with acute uveitis, recurrent iridocyclitis, or chronic uveitis treatable by topical corticosteroid were enrolled. Treatment regimen was one or two drops every hour during Week 1, every two hours during Week 2, four times a day during Week 3, and once a day for the last three days. Efficacy and safety were determined on Days 3, 4, 7 to 10, 14, 21, and 28. A poststudy evaluation was conducted 36 to 72 hours after treatment was stopped.

RESULTS

When anterior chamber cell and flare were measured, rimexolone 1% was found to be as effective as 1% prednisolone. The largest difference observed between treatments was 0.5 score unit, not clinically significant. There were no statistically significant differences in cell scores in either study (P > .05). No statistically significant differences in flare scores were found except at Day 28 in Study One (P = .04). Also, prednisolone was found to be more likely than rimexolone to cause a clinically significant increase (10 mm Hg or more) in intraocular pressure (1.7 times more likely in Study One, eight times more likely in Study Two).

CONCLUSION

Rimexolone 1% ophthalmic suspension is safe and effective for the treatment of uveitis.

A high dose (up to 200 mg) tolerance and efficacy study of intra-articular rimexolone (Org 6216) in rheumatoid synovitis of the knee

Twenty patients with classical or definite rheumatoid arthritis received one intra-articular injection of 40, 80, 120, 160 or 200 mg rimexolone (Org 6216) into one knee joint. Rimexolone was well tolerated and the incidence of side-effects was low. A beneficial effect was sustained over the study period of 94 days and a long-lasting effect was observed in 84% of the patients after one year and in 79% after 2 years. Safety parameters remained unaffected. Individual changes in adrenal response to ACTH and morning cortisol levels did not correlate with the dose or with serum levels of rimexolone. Rimexolone showed linear kinetics. The mean residence time in the intra-articular depot was 44 days (SD +/- 53) with a median of 26 days. Ninety percent was absorbed after 4 months. Outside the intra-articular depot the mean residence time was less than 0.1 days.

The long-term safety of danazol in women with hereditary angioedema

Although the short-term safety (less than or equal to 6 months) of danazol has been established in a variety of settings, no information exists as to its long-term safety. We therefore investigated the long-term safety of danazol by performing a retrospective chart review of 60 female patients with hereditary angioedema treated with danazol for a continuous period of 6 months or longer. The mean age of the patients was 35.2 years and the mean duration of therapy was 59.7 months. Virtually all patients experienced one or more adverse reactions. Menstrual abnormalities (79%), weight gain (60%), muscle cramps/myalgias (40%), and transaminase elevations (40%) were the most common adverse reactions. The drug was discontinued due to adverse reactions in 8 patients. No patient has died or suffered any apparent long-term sequelae that were directly attributable to the drug. We conclude that, despite a relatively high incidence of adverse reactions, danazol has proven to be remarkably safe over the long-term in this group of patients.

Pseudohypertestosteronemia during danazol therapy. A case report

Several steroid radioimmunoassay kits, particularly testosterone, cross-react with danazol, producing false elevations of serum steroid levels. A patient taking danazol simultaneously developed signs of virilization and an apparent 15-fold elevation in her serum testosterone. Discontinuation of danazol resulted in a prompt return to physical and biochemical normality.

Danazol induced pancreatitis and hepatitis

Danazol, a C17 alkylated anabolic steroid, has been tried as a hormonomodulator in the management of systemic lupus erythematosus. We report the case of a patient receiving 400 mg of danazol per day who developed mild pancreatitis associated with hepatitis, both induced by danazol.

Benign intracranial hypertension associated with danazol

We describe a case of benign intracranial hypertension (BIH) whose onset coincided with treatment of danazol for menorrhagia. No other causative factors were identified. Headache and visual symptoms occurring in patients treated with danazol therefore require careful assessment, so that visual failure from advanced BIH can be avoided by appropriate treatment.

Insulin-dependent diabetes mellitus associated with danazol

Insulin-dependent diabetes mellitus developed in a young woman 8 weeks after the initiation of danazol for treatment of pelvic endometriosis. After discontinuation of danazol the diabetes completely resolved. We suspect a possible cause-and-effect relationship, which has not previously been reported in the literature.

Danazol and hepatic neoplasia: a case report

Although hepatic side-effects of danazol are well known, the occurrence of hepatic tumours is not well documented. We report a case of hepatocellular adenoma occurring in a 35-year-old woman with endometriosis who had been taking danazol over a three year period.

Danazol-induced hypercalcaemia in alphacalcidol-treated hypoparathyroidism

We report a case of idiopathic hypoparathyroidism, maintained on alphacalcidol who developed hypercalcaemia during treatment with danazol for endometriosis.

Preventive effect of traditional herbal medicine, shosaiko-to, on danazol-induced hepatic damage

The incidence of the hepatic damage during treatment with danazol (D), indicated by increased serum GOT, GPT and LDH levels, has been shown to be high especially in Japan. Thus, the preventive effect of the traditional herbal medicine, shosaiko-to (SS) was investigated in the administration of D and SS for 16 weeks (D + SS group, N = 9) and the pre-administration of SS for about 4 weeks followed by D and SS for 16 weeks (SS----D + SS group, N = 15). The incidence of serum GOT, GPT and LDH levels of more than normal range during the administration of danazol in the D + SS group was similar to that in the previous study of the administration of D alone. But it was significantly lower in the SS----D + SS group than the D + SS group. The mean levels of serum GOT and GPT were much lower in the SS----D + SS group than the D + SS group throughout the administration of danazol and the difference was significant at 8, 10 and 12 weeks in serum GOT levels and at 4 weeks in serum GPT levels. These results indicate that the pre-administration of SS has great efficacy in the prevention of danazol-induced hepatic damage.

[Prevention of iatrogenic hyperandrogenism]

The androgen effect of some hormonal compounds are sometimes hidden behind a nomenclature or associations. It is necessary to know how to decipher these messages, confusing at times, in order to have a clear idea of the nature of the compounds which are prescribed.

Danazol-induced cholestasis

A 39-yr-old female on high-dose Danazol presented with jaundice and pruritus. Danazol-induced cholestasis was suspected, and the drug was discontinued. A liver biopsy revealed panlobular cholestasis with portal and periportal inflammation. The cholestasis resolved completely in 8 wk. This is a rare case of Danazol-induced cholestasis and should be considered in the differential diagnosis of drug-induced liver injury.

Pseudotumor cerebri induced by danazol

Intracranial hypertension with papilledema occurred in two patients receiving danazol therapy for either cyclic neutropenia or immune hemolytic anemia. Results of clinical, laboratory, and neuroradiologic studies showed no apparent cause for the condition in Case 1 and the papilledema resolved one month after discontinuing danazol. Carotid angiography in Case 2 demonstrated cerebral venous sinus thrombosis; the papilledema showed gradual improvement after cessation of danazol. An additional seven cases of pseudotumor cerebri presumed secondary to danazol therapy have been reported to the Food and Drug Administration. The papilledema resolved in all seven cases soon after discontinuing danazol. A drug-induced complication should be suspected, and alternative therapy sought, in patients who develop intracranial hypertension associated with administration of danazol.

Danazol and internal carotid artery thrombosis

The case of a 47-year-old woman suffering from a CT-assessed ischemic right hemisphere stroke, which occurred after a 2-month treatment with danazol (a synthetic androgen), is reported. The patient's thrombocytosis in association with danazol treatment and its possible correlations with the thrombotic event are discussed.

Ischemic colitis in a 33-year-old woman on danazol treatment for endometriosis

A 33-yr-old Japanese woman, married, no parity, was treated for endometriosis. Danazol 400 mg a day was initiated on September 25, 1986, for 21 consecutive days. She became severely constipated and had left lower abdominal colic pain. Five days later, she had to be admitted to the hospital, because she had had no bowel movements for 12 days and the abdominal pain was severe. On the day after admission, she had frequent painful bowel movements. The stool was blood-tinged, but pathogenic bacteria were nil. Ischemic colitis of the stricture type was identified. She was treated with hyperalimentation and anticholinergic agents. At 3 months and 5 days after discharge from hospital, danazol 400 mg per day was readministered, and 11 days later, the patient again became constipated and complained of the same pain in the left flank. We consider that danazol-induced constipation played a role in the onset of the ischemic colitis.

Serum bile acid concentrations as an indicator of liver dysfunction induced during danazol therapy

The effects of danazol therapy (600 mg/day) on the liver function of 16 women with endometriosis were investigated. The primary bile acids (cholic acid [CA] and chenodeoxycholic acid [CDCA]) were analyzed with radioimmunoassays in the fasting state and after a test meal. Also, the conventional liver function tests were performed. Ultrasonography was used to detect any possible changes in the gallbladder function. The fasting concentrations of CA increased (P less than 0.05) during therapy, while those of CDCA did not change. The ratio of CA/CDCA also increased (P less than 0.001). The maximal response of CA after the test meal increased (P less than 0.01) during the trial. As regards the other liver function tests, only the transaminases significantly increased (P less than 0.01) after 1 month of therapy but showed a tendency to decrease later during the trial. The gallbladder's volume and function did not change. All the parameters studied normalized within 1 month of cessation of danazol therapy. Danazol seems to have a rather mild effect on liver function. The analyzed parameters indicate transient cell wall injury and slight disturbances in liver cell uptake and secretion mechanism and also of synthesis activity.

Hepatocellular carcinoma after danazol therapy

Danazol, an inhibitor of pituitary gonadotropin, has been proposed in the treatment of systemic lupus erythematosus (SLE). We report the case of a female patient with SLE in whom a hepatocellular carcinoma was discovered after 4 years of treatment with danazol. Except for 3 days of hypochondrium pain, there were neither clinical signs of liver tumor nor biological abnormalities. An ultrasonography showed 2 tumors of the liver. At histological examination after surgery, one of the tumors was found to be a benign adenoma, while the other was a well differentiated hepatocellular carcinoma. When longterm danazol therapy is required, ultrasonography may be useful for early tumor detection.

[Effects of danazol therapy in endometriosis on the blood picture and blood coagulation]

Over a six-month period, 62 endometriosis patients were given 600 mg per day of the ethisterone derivative danazol. Blood count and coagulation status were checked before and during treatment. There was a significant increase (p less than 0.05) in hemoglobin and hematocrit. There were no changes in RBC, leukocyte count, or thrombocyte count; the mean cellular erythrocyte volume, thrombin time, thromboplastin time, and partial thromboplastin time also remained unchanged, as did factors VII, VIII, X, XII, and alpha-1-antitrypsin. Antithrombin III levels increased, while alpha-2-macroglobulin values decreased. Only the drop in fibrinogen, to pathologic values, and the increase in plasminogen reached significant levels (p less than 0.01). These in part contradictory changes suggest that hypocoagulability occurs under danazol medication; however, its clinical relevance is unclear.

Intra-articular rimexolone in the rheumatoid knee: a placebo-controlled, double-blind, multicentre trial of three doses

One-hundred and thirty-seven patients with classical or definite rheumatoid arthritis, involving at least one knee joint, were randomly allocated to a single intra-articular injection of 10, 20 or 40 mg of rimexolone (Org 6216) or placebo. The follow-up period was 84 days, during which clinical and laboratory assessments were done. Clinical improvement of the treated knee joint was measured by the following variables: pain, tenderness, morning stiffness, swelling, range of movement and walking ability. Placebo response was considerable. However, clinical improvement with rimexolone at 20 mg and 40 mg was significantly superior to placebo for most of the variables, whilst with the 10 mg dose only reduction of tenderness was significantly superior. The duration of improvement was longest with 40 mg of rimexolone. One single, intra-articular injection of this dose into the affected knee joint provided significant reduction in pain, tenderness and stiffness and improved the range of movement and walking ability for a period of 8 to 12 weeks.

Clinically significant danazol-carbamazepine interaction

In six patients with epilepsy and fibrocystic breast disease the concentration in serum of antiepileptic drugs was obtained before, during, and after danazol therapy. Carbamazepine serum levels increased almost twofold in the presence of danazol. Thus, interaction between carbamazepine and danazol producing acute carbamazepine toxicity is clinically significant. If these drugs are administered concurrently, an awareness of the potential for this drug-drug interaction along with monitoring of carbamazepine levels is required for optimal patient care.

Endocrine consequences of danazol treatment in menorrhagia

In order to study the endocrine side-effects of danazol, 15 patients with severe, benign menorrhagias, were individually treated with this drug to stop bleeding. LH, FSH, testosterone, free testosterone, DES-S, androstenedione, prolactin, estradiol and cortisol serum concentrations were measured before and after the 3 month treatment period. Danazol was found to be effective in reducing the amount of bleeding in patients with benign, severe menorrhagias; however, the weight gain of patients was significant during the 3 month period. LH and estradiol concentrations decreased; testosterone, free testosterone and dehydroepiandrosterone sulfate increased; prolactin, FSH, androstenedione and cortisol serum concentrations did not change, and SHBG disappeared from the serum, during the treatment period. We are of the opinion that danazol is an effective drug in menorrhagias with side-effects. In our view the hyperandrogenicity is the most important side-effect of this substance, which might be the result of some metabolites, but which might be the effect of a peripheral action of the drug as well.