Prednisolone Combination Therapy Research Articles

Evaluation the efficacy of NB-UVB treatment alone in comparison with combination therapy of NB-UVB and oral prednisolone in treatment of vitiligo

Background: The treatment landscape for vitiligo has witnessed diverse approaches yielding variable outcomes. Objective: To discern the optimal approach in terms of both tolerability and efficacy by comparing Narrow Band Ultraviolet B (NB-UVB) phototherapy with adjunctive oral mini pulse (OMP) prednisolone tablets. Patients and Methods: A total of eighty-seven individuals with progressive vitiligo were enrolled in a one-year study, with participants allocated randomly across three study groups through a continuous selection method. Group 1 received a combination of NB-UVB and OMP prednisolone tablets, group 2 underwent NB-UVB treatment only, and group 3 received OMP prednisolone tablets alone. Clinical assessments were conducted at three- and six-month intervals, and statistical analyses were performed utilizing descriptive and bivariate techniques, including the chi-square test, to gauge the significance of differences between the various groups. Results: In Group 1 (NB-UVB + OMP), substantial improvement was observed in 41.4%, accompanied by moderate improvement in 44.8% of patients. Group 2 (NB-UVB) demonstrated marked improvement in 31.0% and moderate improvement in 38.0%. In Group 3 (OMP), a lower proportion experienced marked (13.8%) or moderate (3.4%) improvement. Chi-square test findings indicated that the combination of NB-UVB and OMP correlated significantly with marked and moderate improvement in contrast to OMP alone, with respective values of χ² = 6.434 (p = 0.001) and χ² = 7.831 (p = 0.015) after a six-month follow-up. Conclusion: Through a comprehensive evaluation of three treatment modalities in vitiligo patients, it was established that the sole application of oral mini pulse steroids (OMP) held an adjunctive value, lacking substantial efficacy on its own. Remarkably, the amalgamation of Narrow Band UVB and OMP presented a clear advantage over either treatment administered independently.

Evaluation of the effectiveness of using prednisolone, tacrolimus, and intravenous immunoglobulin combination therapy on immune-mediated necrotizing myopathy-A non-randomized, observational research.

To recruit immune-mediated necrotizing myopathy (IMNM) patients with extramuscular manifestations who were refractory to initial therapy with either monotherapy with prednisolone or dual therapy with prednisolone and immunosuppressants. These patients subsequently received a combination of prednisolone, tacrolimus, and intravenous immunoglobulin (IVIG), and the efficacy of this treatment regimen was assessed in patients with IMNM. ①Clinical data and treatment measures are as follows: This study enrolled IMNM patients who were treated at the Neurology Department of the First Medical Center of PLA General Hospital from April 2020 to May 2023. These patients received a combination therapy of prednisolone, tacrolimus, and IVIG. ②Observational indicators included manual muscle test for 8 groups of muscles (MMT-8), muscle enzyme levels (creatine kinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST)), and myositis disease activity assessment tool (MDAAT). This study enrolled eight patients. All observational indicators declined after treatment compared to before treatment, and these changes were statistically significant. Moreover, extramuscular manifestations also ameliorated compared to before treatment. The combination therapy of prednisolone, tacrolimus, and IVIG has demonstrated favorable efficacy in IMNM and broadened the treatment options for this disease. However, the results still require further validation by large-scale and randomized controlled studies.

Predicting the mechanism of action of Silymarin —Pueraria lobata—Prednisolone combination in the treatment of alcoholic liver disease based on network pharmacology and molecular docking.

Objective: To predict the key targets, active ingredients, and pathways of action of Silymarin-Pueraria lobata- Prednisolone combination for the treatment of Alcoholic Liver Disease (ALD) based on the web-based pharmacology and molecular docking approach, and to determine the biological processes and molecular functions of its action. Methods: Several databases including TCMSP, Pharm Mapper, PubChem, TTD, Drugbank, OMIM and UniProt were used to identify the targets of Silymarin, Pueraria lobata and Prednisolone for the treatment of ALD. The main targets of the combination of Chinese and Western medicines were identified by Venn diagram analysis. Protein interaction networks were constructed and information on biological processes and molecular functions was obtained with the help of the STRING web site. Target genes were visualised using the Cytoscape software. Potential targets were analysed using the Metascape website. Molecular docking was performed with the key target genes screened. This was done to confirm the drug compounds identified in the enrichment results.Results: A total of 95 targets were identified in the combination therapy of Silymarin-Pueraria lobata-Prednisolone for the treatment of ALD. The key targets include ALB, IL6, and TNF. When used for treating ALD, the therapy primarily acts on the following functions: Chemical carcinogenesis - receptor activation, Neuroactive ligand-receptor interaction, Pathways in cancer, and Calcium signaling pathway, among others. In the treatment of ALD, 161 pathways are primarily targeted, including those involved in blood circulation, cellular response to organic cyclic compounds, cationic acid, and various other pathways. These pathways include response to organic cyclic compounds, circulatory system processes, nuclear receptor activity, ligand-activated transcription factor activity, neurotransmitter activity, and neurotoxicity, as well as neurotransmitter receptor activity, and 157 other molecular functions for the combination therapy of ALD. Research using molecular docking techniques indicates that the combination therapy of Silymarin, Pueraria lobata and Prednisolone is effective in the treatment of ALD due to the high affinity observed between the core target proteins and the active ingredients of the drug.Conclusion: The primary objective of combining Silymarin, Pueraria lobata, and Prednisolone therapy for ALD was screened and confirmed via network pharmacology and molecular docking. The analysis also predicted the possible mechanism of action for the combination of Chinese and Western medicines in ALD treatment, laying a solid foundation for further development of Silymarin-Pueraria lobata-Prednisolone therapy. Providing a theoretical framework for the subsequent experimentation and clinical validation of Silymarin-Pueraria lobata-Prednisolone combination therapy for ALD. Concurrently, it serves as a reference for enhancing network pharmacology and molecular docking methodologies when predicting the mechanism of actions of combined Chinese and Western therapies for various diseases.

An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis

Patients with autoimmune hepatitis (AIH) almost invariably require lifelong immunosuppressive treatment. There is genuine concern about the efficacy and tolerability of the current standard combination therapy of prednisolone and azathioprine. Mycophenolate mofetil (MMF) has emerged as an alternative option. The aim of this study was to compare MMF to azathioprine as induction therapy for AIH. In this 24-week, prospective, randomised, open-label, multicentre superiority trial, 70 patients with treatment-naive AIH received either MMF or azathioprine, both in combination with prednisolone. The primary endpoint was biochemical remission defined as normalisation of serum levels of alanine aminotransferase and IgG after 24 weeks of treatment. Secondary endpoints included safety and tolerability. Seventy patients (mean 57.9 years [SD 14.0]; 72.9% female) were randomly assigned to the MMF plus prednisolone (n= 39) or azathioprine plus prednisolone (n= 31) group. The primary endpoint was met in 56.4% and 29.0% of patients assigned to the MMF group and the azathioprine group, respectively (difference, 27.4 percentage points; 95% CI 4.0 to 46.7; p= 0.022). The MMF group exhibited higher complete biochemical response rates at 6 months (72.2% vs. 32.3%; p= 0.004). No serious adverse events occurred in patients who received MMF (0%) but serious adverse events were reported in four patients who received azathioprine (12.9%) (p= 0.034). Two patients in the MMF group (5.1%) and eight patients in the azathioprine group (25.8%) discontinued treatment owing to adverse events or serious adverse events (p= 0.018). In patients with treatment-naive AIH, MMF with prednisolone led to a significantly higher rate of biochemical remission at 24 weeks compared to azathioprine combined with prednisolone. Azathioprine use was associated with more (serious) adverse events leading to cessation of treatment, suggesting superior tolerability of MMF. This randomised-controlled trial directly compares azathioprine and mycophenolate mofetil, both in combination with prednisolone, for the induction of biochemical remission in treatment-naive patients with autoimmune hepatitis. Achieving complete remission is desirable to prevent disease progression. Patients assigned to the mycophenolate mofetil group reached biochemical remission more often and experienced fewer adverse events. The findings in this trial may contribute to the re-evaluation of international guidelines for the standard of care in treatment-naive patients with autoimmune hepatitis. #NCT02900443.

Effects of oral prednisolone and fluticasone nasal spray in the management of chronic rhinosinusitis with polyposis: A prospective observational study

To study the effects of combination therapy with oral prednisolone and topical fluticasone propionate nasal spray in patients with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP). To study the improvement in symptom scores, Endoscopic and CT scores before and after treatment with combination therapy.This prospective observational study was conducted on 50 patients attending the Outpatient Department of Otorhinolaryngology, J.L.N Hospital and Research Centre, Bhilai (Chhattisgarh), India over a period of 6 months from February 2020 to July 2020. Patients with symptoms of CRSwNP persisting for more than 12 weeks were thoroughly examined clinically along with Nasal endoscopy and Computed Tomography scan of Nose and Paranasal sinuses (CT PNS) and pre-treatment Visual Analog Scale (VAS), Lund & Mackay Scores for Endoscopic and CT findings were noted. Patients were treated with combination therapy of oral prednisolone and fluticasone propionate nasal spray and post treatment scores were noted using similar scales during the follow up visits and the results were statistically analysed.Total mean age of patients suffering from CRSwNP in our study was 47.3 ± 12.58. Males were affected more by CRSwNP than females (76% vs 24%). At the end of 3 months from baseline 48 patients (96%) showed a reduction in nasal discharge, 47 patients (94%) showed a reduction in nasal obstruction, 25 patients (50%) showed improvement in facial pain and 17 patients (34%) showed improvement in hyposmia. Overall post treatment Visual Analog Symptom (VAS) score improved in 42 patients (84%), Nasal endoscopy (Lund - Mackay scoring) improved in 43 patients (86%) and Radiological CT PNS & Nose (Lund - Mackay Scoring) improved in 33 patients (66%).We found that combined therapy with oral prednisolone and fluticasone propionate nasal spray for 3 weeks is very effective in reducing the symptoms of chronic rhinosinusitis along with decrease in nasal secretions, edema and polyp size.

Comparison of efficacy and safety of corticosteroids and vigabatrin plus corticosteroids in infantile spasm: An open label randomized control trial.

Objective: To compare efficacy and safety of corticosteroids and combined therapy with corticosteroids and vigabatrin in infantile spasm. Study Design: Randomized Controlled Trial. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health Multan, Pakistan. Period: November 2020 to November 2022. Material & Methods: A total of 320 children of either gender aged 1-24 month with clinical diagnosis of infantile spasm were included. Infants were randomized into either receiving prednisolone (Group-A) or vigabatrin plus prednisolone (Group-B). Demographical information along with treatment outcomes and adverse effects were noted. Final outcomes were labeled at day-180. Results: In a total of 320 children, 170 (53.1%) were male. Overall, the mean age was 1.3±0.5 years while 166 (51.9%) children were aged between 1 to 2 years. A total of 166 (51.9%) children responded to allocated treatment. The response rate was significantly better in Group-B (n=118, 73.8%) versus Group-A (n=48, 30.0%), p<0.0001. Significantly more children in Group-A missed follow-ups in comparison to those in Group-B (11.8% vs. 1.9%, p=0.0006). Mortality was statistically similar in both study groups (2.5% vs. 1.9%, p=0.7023). The most treatment related adverse effect was noted to be increased appetite and/or weight, gastrointestinal symptoms and sleep disturbance in 253 (79.1%), 121 (37.8%) and 117 (36.6%) respectively. Increased appetite and/or weight gain was significantly more in Group-A (p<0.0001). Conclusion: The findings of this study are in support of using combination therapy of prednisolone and vigabatrin instead of monotherapy for patients with infantile spasm as reflected by higher number of responders to therapy.

Non-steroidal anti-inflammatory agents for treating cystoid macular edema following cataract surgery.

Non-steroidal anti-inflammatory agents for treating cystoid macular edema following cataract surgery.

Evaluation of Medication Instruction Sheets for Patients Undergoing R-CHOP Therapy in Non-Hodgkin's Lymphoma.

High-dose chemotherapy is frequently administered to patients with hematologic malignancies, thereby causing severe adverse drug reactions (ADRs) at a relatively high frequency. To precisely monitor ADRs, we developed a medication instruction sheet (MIS) for patients who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) combination therapy for non-Hodgkin's lymphoma (NHL). Herein, we evaluated the usefulness of the MIS for managing ADRs in patients who received R-CHOP therapy. We included patients aged ≥20 years who received R-CHOP therapy as first-line treatment for NHL at the Department of Hematology, Kyushu University Hospital, between August 2014 and December 2018. Medical professionals evaluated the possible occurrence of ADRs according to the present MIS and ADRs were graded according to the Common Toxicity Criteria, version 4.0 (National Cancer Institute, Bethesda, MD, USA). Finally, the accuracy of the MIS in predicting the occurrence of ADRs of different grades and during definite periods was evaluated. Seventy-five patients with NHL were included in the present study. Overall, 359 ADR events were monitored, which were predicted ADR items listed in the MIS. Among these, 254 (71%) events occurred during the same period as those listed in the MIS. The onset timing of any grade of an infusion reaction and peripheral neuropathy precisely matched those listed in the MIS. However, the accuracy of the MIS was reduced in patients with thrombocytopenia (42%). The present MIS could be useful for monitoring ADRs in patients with cancer undergoing R-CHOP therapy.

RETROSPECTIVE EVALUATION OF PATIENTS WITH LANGERHANS CELL HISTIOCYTOSIS FOLLOWED IN OUR CLINIC

Langerhans cell histiocytosis (LCH) is a rare histiocytic disorder that can be especially seen in children and young adults. The clinical presentation of patients with LCH varies according to the sites of involvement. In about half of patients, the disease is limited to a single organ system and bone involvement is very common. In this study, it was aimed to retrospectively evaluation the patients diagnosed with LCH who were followed up and treated in our clinic. The data of patients over the age of 18 years who were followed up and treated in Bozyaka Training and Research Hospital Hematology Clinic between 2015-2021 were scanned retrospectively from the hospital system. Data of 6 patients were obtained. The mean age of the patients was 33.6. There was no difference between the genders. Pain was the reason for admission in 4 patients and was the most common symptom. While the most frequently involved system was the skeletal system with 5 patients, lung involvement was seen in 2 patients. Vinblastine and prednisolone combination therapy was given to 1 patient, who developed steroid-related avascular necrosis. One patient who was planned for combination treatment LCH is a rare disease especially seen in children and young adults. It can involve the skeletal system, lungs, and other organs. The prognosis is often good with excision of the lesion or systemic treatment.

Serum tenascin-C predicts resistance to steroid combination therapy in high-risk Kawasaki disease: a multicenter prospective cohort study

BackgroundTenascin-C (TN-C) is an extracellular matrix glycoprotein related to tissue inflammation. Our previous retrospective study conducted in 2016 revealed that the serum tenascin-C level was higher in patients with Kawasaki disease (KD) who were resistant to intravenous immunoglobulin (IVIG) and developed coronary artery lesions (CALs). The present study is a prospective cohort study to assess if the serum level of tenascin-C could be used as a novel biomarker to predict the risk of resistance to initial treatment for high-risk patients.MethodsA total of 380 KD patients were registered and provided serum samples for tenascin-C measurement before commencing their initial treatment. Patients who did not meet the inclusion criteria were excluded from analysis; of the 181 remaining subjects, there were 144 low-risk patients (Kobayashi score: ≤4 points) and 37 high-risk patients (Kobayashi score: ≥5 points). The initial treatments for low-risk patients and high-risk patients were conventional therapy (IVIG with aspirin) and prednisolone combination therapy, respectively. The patient clinical and laboratory data, including the serum tenascin-C level, were compared between initial treatment responders and non-responders.ResultsIn the low-risk patients, there was no significant difference in the median levels of serum tenascin-C between the initial therapy responders and non-responders. However, in the high-risk patients, the median serum tenascin-C level in initial therapy non-responders was significantly higher than that in initial therapy responders (175.8 ng/ml vs 117.6 ng/ml).ConclusionsSerum tenascin-C could be a biomarker for predicting the risk of high-risk patients being non-responsive to steroid combination therapy.Trial registrationThis study was a prospective cohort study. It was approved by the ethics committee of each institute and performed in accordance with the Declaration of Helsinki.

Chronic active EBV infection in refractory enteritis with longitudinal ulcers with a cobblestone appearance: an autopsied case report

BackgroundChronic active Epstein–Barr virus infection (CAEBV) is defined as Epstein–Barr virus (EBV)-positive T/NK cell-related neoplasia, and its major clinical symptom is systemic inflammation presenting as infectious mononucleocytosis, whereas enteritis and diarrhea are minor clinical symptoms. The complex mixture of tumorigenic processes of EBV-positive cells and physical symptoms of systemic inflammatory disease constitutes the varied phenotypes of CAEBV. Herein, we describe a case of CAEBV that was initially diagnosed as Crohn’s disease (CD) based on ileal ulcers and clinical symptoms of enteritis.Case presentationA 19-year-old woman complained of abdominal pain and fever. Blood examination showed normal blood cell counts without atypical lymphocyte but detected modest inflammation, hypoalbuminemia, slight liver dysfunction, and evidence of past EBV infection. The esophagogastroduodenoscopic findings were normal. However, colonoscopy revealed a few small ulcers in the terminal ileum. The jejunum and ileum also exhibited various forms of ulcers, exhibiting a cobblestone appearance, on capsule endoscopy. Based on these clinical findings, she was strongly suspected with CD. In the course of treatment by steroid and biologics for refractory enteritis, skin ulcers appeared about 50 months after her initial hospital visit. Immunohistology of her skin biopsy revealed proliferation of EBV-encoded small RNA (EBER)-positive atypical lymphocytes. We retrospectively assessed her previous ileal ulcer biopsy before treatment and found many EBER-positive lymphocytes. Blood EBV DNA was also positive. Therefore, she was diagnosed with extranodal NK/T-cell lymphoma with CAEBV-related enteritis rather than CD. She was treated with cyclosporine and prednisolone combination therapy for CAEBV-related systemic inflammation and chemotherapy for malignant lymphoma. Unfortunately, her disease continued to progress, leading to multiple organ failure and death at the age of 23 years.ConclusionClinicians need to remember the possibility of CAEBV as a differential diagnosis of refractory enteritis. Enteritis with intestinal ulcer is a rare symptom of CAEBV, and it is impossible to acquire a definitive diagnosis by ulcer morphology only. In cases where the possibility of CAEBV remains, tissue EBVR expression should be checked by in situ hybridization and blood EBV DNA.

P0287LONG-TERM CLINICAL OUTCOMES IN IDIOPATHIC MEMBRONOUS NEPHROPATHY TREATED BY CYCLOSPORINE AND PREDNISOLONE

Abstract Background and Aims Membranous nephropathy (MN) is the most common primary glomerular disease diagnosed in older patients. MN in adults is most often idiopathic, and risk factors of clinical findings for progressive idiopathic MN (iMN) seems to be older age at onset, male sex, and nephrotic-range proteinuria persisting for several months. Immunosuppressive therapy should be applied to the patients with iMN who have risk factors for progression, however little is known about the most effective regimen of immunosuppressive therapy. In addition, long-term prognosis of iMN for each immunosuppressive regimen is unclear. Most of the patients with iMN at our center were treated by prednisolone (PSL) and cyclosporine (CYA) combination therapy, and commencement of therapy was around the time of renal biopsy. The objective of this study is to assess medium to long-term outcome of treated iMN patients with CYA at our center. Method Retrospective data were collected from January 2000 to December 2014 on all consecutive 1080 native renal biopsy at our center. 102 cases were diagnosed as MN. Of 102 MN cases, 43 cases were iMN, which was IgG4 dominant or codominant in immunofluorescence of IgG subclass. Secondary MN is diagnosed by clinical history of possible drug use, the presence of malignancy, positive serologic tests for both infection and connective tissue diseases, hepatitis B or hepatitis C virus positive, and full house immunofluorescence. Results Of 43 iMN cases, there were 4 cases who were treated with only nonimmunosuppressive therapies, 5 cases who were treated with PSL, and 34 cases who were treated with CYA combination. Immunosuppressive therapy commenced within one month before and after renal biopsy. Immunosuppressive regimen was determined by each doctor. CYA was administered once-daily, and the area under the concentration-time curve up to 4 hour after administration of CYA (AUC0-4h) was determined in each patient. No infectious complications were found. The duration of CYA use was 194.7±848.9 days (median 786.5 days), and follow-up period of CYA group was 3026.4±1608.0 days. There were no significant differences between PSL group and CYA group in age (53.4±20.6 years vs. 64.1±10.6 years, p=0.162), sex (1 male 4 female vs. 23 male 11 female ,p=0.162), urinary protein (1.37±0.65 g/gCre vs. 5.44±3.64 g/gCre, p=0.0679), serum creatinine at the time of renal biopsy (0.66±0.19 mg/dl vs. 1.09±0.57 mg/dl, p=0.352), a 30% eGFR decline (0 cases vs. 2 cases), cases achieved complete remission (CR) (5 cases vs. 26 cases, p=0.196), and time from commencement of immunosuppressive therapy to CR (748.2±795.5 days vs. 422.2±379.9 days, p=0.242). There were no significant differences between non-remission cases in CYA group (8 cases) and remission cases in CYA group (26 cases) in age, sex, and urinary protein, but serum creatinine was significantly greater in non-remission cases than remission cases in CYA group (1.75±1.01 mg/dL vs. 0.94±0.29mg/dL, p=0.0251). There were no significant differences between non-recurrent cases in CYA group (16 cases) and recurrent cases (10 cases) in CYA group in age, sex, urinary protein, and serum creatinine at the time of renal biopsy. Conclusion Between PSL group and CYA group, there were no significant differences in age, and sex at the time of biopsy, and there was a trend that urinary protein was greater in CYA group than in PSL group (p=0.0679). Due to the tendency that urinary protein at the biopsy was greater in CYA group, no significant differences were seen in the remission rate and the time from commencement of immunosuppressive therapy to remission between PSL group and CYA group. Despite long duration of CYA use, infectious complications and renal function deterioration were not seen, so CYA can use safely by dose adjustment by AUC0-4h. Further study is needed to provide enough evidence of effectiveness of CYA combination therapy.

Mycophenolate mofetil plus prednisolone combination therapy for necrotising leukoencephalitis in a dog: long-term clinical observation, serial imaging analysis and histopathological findings

An 8-year-old intact male mixed-breed dog presented with tetraparesis, right side head tilt, and cluster seizure-like episodes. Based on the magnetic resonance imaging and cerebrospinal fluid analysis results, meningoencephalitis of an unknown aetiology was strongly suspected. The patient survived for 963 days under mycophenolate mofetil plus prednisolone therapy and was ultimately diagnosed with necrotising leukoencephalitis. This report describes the clinical findings, the serial magnetic resonance imaging characteristics, and the histopathologic features of a case of necrotising leukoencephalitis and the long-term survival after mycophenolate mofetil plus prednisolone therapy.

Etoposide and Corticosteroid Combination Therapy Improves Acute Respiratory Distress Syndrome in Mice.

Excessive inflammation reactions with a cytokine storm in the lungs have historically been thought as the primary cause of fatal acute respiratory distress syndrome (ARDS). However, interruption of inflammatory cytokine activation failed to attenuate ARDS, suggesting that other therapies are required to treat this illness and improve survival. Etoposide (ET), a cytotoxic agent, and prednisolone (PSL), a corticosteroid with strong anti-inflammatory activity, have been used to treat other disease involving similar cytokine-activated macrophages and hemophagocytic activity. However, they have not been previously tested as ARDS therapeutics alone or in combination. In the present study, we used a fatal ARDS mouse model induced via administration of α-galactosylceramide and lipopolysaccharide, which resulted in the development of severe lung injury with hypercytokinemia and hemophagocytosis, all of which were observed in ARDS patients infected with highly pathogenic respiratory viruses. The ET and PSL combination therapy, but not ET or PSL alone, reduced the recruitment and activation of inflammatory cells including macrophages, natural killer T cells, and neutrophils, and significantly improved the survival rate in this model. Furthermore, whereas ET alone improved lung edema, it did not increase the survival rate, indicating the necessity of PSL in the treatment of ARDS. Surprisingly, combination therapy did not reduce the production of cytokines and chemokines in the lungs, demonstrating that inflammatory cells, rather than hypercytokinemia, are the direct target of these compounds and primary cause of ARDS-related death. Thus, combination therapy with ET and PSL that targets inflammatory cells has the potential to attenuate fatal ARDS.

Combination Therapy of Prednisolone and Toceranib Phosphate in a Dog with Malignant Metastatic Insulinoma

Combination Therapy of Prednisolone and Toceranib Phosphate in a Dog with Malignant Metastatic Insulinoma

Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (Post RAISE): a multicentre, prospective cohort study

The RAISE study showed that additional prednisolone improved coronary artery outcomes in patients with Kawasaki disease at high risk of intravenous immunoglobulin (IVIG) resistance. However, no studies have been done to test the steroid regimen used in the RAISE study. We therefore aimed to verify the efficacy and safety of primary IVIG plus prednisolone. We did a multicentre, prospective cohort study at 34 hospitals in Japan. We included patients diagnosed with Kawasaki disease according to the Japanese diagnostic criteria, and excluded those who were treated at other hospitals before being transferred to a participating hospital. Patients who were febrile at diagnosis received primary IVIG (2 g/kg per 24 h) and oral aspirin (30 mg/kg per day) until the fever resolved, followed by oral aspirin (5 mg/kg per day) for 2 months after Kawasaki disease onset. We stratified patients using the Kobayashi score into predicted IVIG non-responders (Kobayashi score ≥5) or predicted IVIG responders (Kobayashi score <5). For predicted non-responders, each hospital independently decided whether to add prednisolone (intravenous injection of 2 mg/kg per day for 5 days) to the primary IVIG treatment, according to their respective treatment policy, and we further divided these patients based on the primary treatment received. The primary endpoint was the incidence of coronary artery abnormalities determined by two-dimensional echocardiography at 1 month after the primary treatment in predicted non-responders treated with primary IVIG plus prednisolone. Coronary artery abnormalities were defined according to the criteria of the Japanese Ministry of Health and Welfare and of the American Heart Association (AHA). This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, number UMIN000007133. From July 1, 2012, to June 30, 2015, we enrolled 2628 patients with Kawasaki disease, of whom 724 (27·6%) were predicted IVIG non-responders who received IVIG plus prednisolone as primary treatment. 132 (18·2%) of 724 patients did not respond to primary treatment. Among patients with complete data, coronary artery abnormalities were present in 40 (incidence rate 5·9%, 95% CI 4·3-8·0) of 676 patients according to the AHA criteria or in 26 (3·8%, 2·5-5·6) of 677 patients according to the Japanese criteria. Serious adverse events were reported in 12 (1·7%) of 724 patients treated with primary IVIG plus prednisolone; two of these patients had hypertension and bacteraemia that was probably related to prednisolone. One patient died possibly due to severe inflammation from the Kawasaki disease itself. Primary IVIG plus prednisolone therapy in this study had an effect similar to that seen in the RAISE study in reducing the non-response rate and decreasing the incidence of coronary artery abnormalities. A primary IVIG and prednisolone combination therapy might prevent coronary artery abnormalities and contribute to lowering medical costs. Tokyo Metropolitan Government Hospitals and the Japan Kawasaki Disease Research Center.

Case of epidermolysis bullosa acquisita with concomitant anti‐laminin‐332 antibodies

Subepidermal autoimmune blistering disease including bullous pemphigoid, pemphigoid gestationis, mucous membrane pemphigoid, anti-laminin-γ1 pemphigoid, linear immunoglobulin A bullous disease and epidermolysis bullosa acquisita (EBA), are all characterized by direct immunofluorescence microscopy or immunoglobulin deposition on the basement membrane zone. Among them, EBA is a rare acquired subepidermal autoimmune blistering disease of the skin and mucous membranes reactive with type VII collagen, a major component of the epidermal basement membrane zone. Anti-laminin-332-type mucous membrane pemphigoid has pathogenic autoantibodies against laminin-332, which is a basement membrane heterotrimeric protein composed of α3, β3 and γ2 laminin chains. We describe a 73-year-old Japanese man presenting with multiple, annular, tense blisters on the lower legs and oral lesions. Despite the severe clinical manifestations, the disease was successfully controlled by combination therapy of oral prednisolone and mizoribine. This case was confirmed to have autoantibodies to both type VII collagen and laminin-332 α3 chain by indirect immunofluorescence of 1 mol NaCl-split normal human skin, various immunoblot analyses and enzyme-linked immunosorbent assays. This case was a rare case of EBA with concomitant anti-laminin-332 antibodies.

Efficacy of Levamisole as a single agent in maintaining remission in steroid dependant nephrotic syndrome

Introduction Levamisole (LEV) is an anti-helminthic drug which subsequently has shown immunomodulatory properties. It has been used successfully in conjunction with low-dose alternate-day prednisolone in steroid dependant nephrotic syndrome (SDNS). This randomized controlled study was carried out between years 2002 and 2005 at a single centre in Sri Lanka to evaluate the efficacy of LEV as a single agent following a prolonged period of combination therapy of LEV and prednisolone. Method Sequential Children with SDNS in stable remission who had been treated with LEV and low dose alternate-day prednisolone (0.1-0.6mg/kg) for 2 years were recruited and randomised into one of two groups. The test group received LEV (2.5 mg/kg) on alternate-days for one year and the control group received no treatment. Urine protein excretion was performed and recorded by parents on daily basis and the finding of 3+ or more proteinuria for three consecutive days was diagnostic of relapse. Results There were 42 in the test group (median age 8.4 years) and 34 in the control group (median age 7.2 years). During one year of follow up, 26/34 in the control group and 8/42 in the test group suffered a relapse. (p Conclusion Levamisole is safe, affordable and effective as a single agent in maintaining remission in SDNS.

Efficacy of mizoribine and prednisolone combination therapy in adult patients with IgA vasculitis.

Immunoglobulin (Ig)A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is one of the most common vasculitis caused by an IgA-mediated immune complex. It occurs most frequently in childhood and less commonly in adulthood. As for the treatment of IgAV in adults, there are few studies dealing with the administration and efficacy of intravenous pulse steroid therapy or combination therapy using prednisolone (PSL) and immunosuppressive drugs. Mizoribine (MZB) is a newly developed immunosuppressive drug with few adverse effects; however, there are currently few studies using MZB in adult patients with IgAV. In this study, we evaluated the efficacy of MZB combined with a course of PSL in adult patients with IgAV. Five patients with adult onset IgAV were enrolled in the study. All patients received oral PSL (initial dose 30-50mg/day), and MZB was administered orally at a single morning dose of 150mg. We investigated the clinical manifestations and prognosis of these patients receiving the combination therapy of MZB and PSL retrospectively. All patients showed complete or partial remission of proteinuria and microscopic hematuria with the combination therapy of MZB and PSL. Furthermore, no significant adverse effects were observed. Although this study had an uncontrolled small group, our results indicate that the combination of MZB with PSL could be a possible new treatment for adult patients with IgAV.

Combination therapy of cyclosporine and prednisolone in a dog with systemic lupus erythematosus

Abstract : An 11-year-old, spayed female poodle presented with fever and shifting lameness. Physical examinationrevealed hyperthermia (40.6 o C), and proteinuria was detected upon urinalysis. Increased neutrophils (83%) and decreasedviscosity were revealed upon synovial fluid analysis. Serum antinuclear antibody was positive at 1 : 80. Based on thesefindings, the dog was diagnosed with systemic lupus erythematosus. Immunosuppressive therapy was initiated withprednisolone and cyclosporine, and the condition was markedly improved after the treatments. This case report describesthe clinical and laboratory findings, imaging characteristics and successful outcomes after prednisolone plus cyclosporinetherapy in a canine systemic lupus erythematosus case.Keywords : antinuclear antibody, cyclosporine, glomerulonephritis, polyarthritis, systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a multisystemicautoimmune disorder in which immunity is directed againstvarious tissues or tissue components [1]. The most commonclinical features include shifting lameness from polyarthritis,ulceration of extremities caused by vasculitis, icteric and palemucous membranes resulting from immune-mediated hemol-ysis, and peripheral edema or pleural effusion due to hypoal-buminemia secondary to glomerulonephritis. Additionally,dermatologic lesions may be present, including crusting, alope-cia, erythema, ulceration, and hyperkeratosis [8].Major signs of SLE are skin lesions, non-erosive polyarthri-tis, hemolytic anemia, glomerulonephritis, polymyositis, leuko-penia, and thrombocytopenia [1]. Minor signs are fever, centralnervous system symptoms, oral ulcerations, lymphadenopa-thy, pericarditis, and pleuritis [2]. The antinuclear antibody(ANA) test and lupus erythematosus (LE) cell preparations areused clinically for the diagnosis of SLE, but until recently, theANA test is considered the most sensitive [3, 14]. Immunosup-pression is vital to treating this abnormal immune response,and patients can be treated with high dose of prednisolone (1–2 mg/kg, per oral [PO], q12h) and cytotoxic drugs, such asazathioprine, cyclosporine, and cyclophosphamide [4, 5]. Thiscase report describes successful treatment using prednisoloneand cyclosporine in a dog with SLE.An 11-year-old, 6.1 kg, spayed female poodle dog pre-sented with fever, lethargy, anorexia, and shifting lameness.The dog had a history of reluctance to stand up and walk,which was intermittent and partially responsive to non-steroi-dal anti-inflammatory drugs. Physical examination was unre-markable except for hyperthermia (40.6