Duration Of Tapering Research Articles

Effect of during of tapering on anaerobic power and capacity in road cyclists

Summary The linear tapering method duration can be determinant for sport performance. Objective The objective of this study was to analyze the effect of linear tapering duration method on anaerobic power and capacity in road cyclists. Materials and methods Seventeen male road cyclists, aged between 18 and 30 years were randomly selected within the study criteria. Participants performed 16 weeks of training, adopting the undulating periodization with weekly variation of the training load. The tapering phase lasted 4 weeks, using the linear tapering method, reducing only the training volume: 85% in the first, 70% in the second, 55% in the third and 40% in the fourth week. The Wingate test was used to evaluate anaerobic power and capacity. Wingate was performed by the cyclists before the start of the season, at the end of the last week of each mesocycle (Preparatory I, Specific I and Specific II) and at the end of each week in the tapering phase. Results The results revealed a time effect for anaerobic power (P 0.05), finishing with attenuation in the fourth week of tapering (P = 0.01). Conclusion It was concluded that 2 weeks of tapering was enough to improve the anaerobic power and capacity in road cyclists.

Seizure recurrence risk in persons with epilepsy undergoing antiepileptic drug tapering.

Antiepileptic drug (AED) tapering in persons with epilepsy (PWE) after 2-3years of seizure freedom is still debatable because of the risk of seizure recurrence. Tapering patterns have wide variability and could impact seizure recurrence; this study aimed to find out the correlation between them. This prospective, observational independent assessor study enrolled PWE undergoing AED tapering in a tertiary care hospital. Data collected included demography, seizure history, AED treatment, and investigational findings. Tapering pattern was assessed based on seizure-free period and AED dose before onset of tapering, dose reduction percentage and frequency, duration of tapering, and follow-up. These variables were compared among the PWE with seizure recurrence and no seizure recurrence. Among 408 enrolled PWE, 181 were on AED monotherapy: levetiracetam (73), valproate (45), carbamazepine (44), phenytoin (16), and clobazam (3). With a minimum 19 (maximum 41months) follow-up, seizure recurrence was reported in 119 (29.2%) PWE. The seizure recurrence was not significantly different in-between mono and polytherapy groups; however, among monotherapy groups seizure recurrence was significantly higher (P=.023) in valproate (35.5%) followed by levetiracetam (28.8%) group. Parameters having significant association with seizure recurrence were duration of epilepsy (P=.03), frequency of seizures before control (P=.002), history of previously failed tapering (P=.04), and history of smoking/alcoholic/tobacco intake (P=.003). There is a wide variation in AEDs tapering pattern and seizure recurrence risk can be minimized by considering the risk factors like history of smoking/alcoholic/tobacco, longer duration of epilepsy, frequency of seizures before control, and previously failed tapering.

Effect of duration of tapering on 100-m freestyle performance in swimmers

Objective: The aim of this study was to analyze the effect of tapering duration on 100-m freestyle performance in swimmers. Method: This is an experimental research with 16 weeks’ duration. Participants were 37 male swimmers aged between 15 and 17 years. The 100-m freestyle performance was evaluated before of the season start (pre-experiment), at the end of last week of each mesocycle (Preparatory, Specific I and Specific II) and the end of each week in the tapering phase. The performance was evaluated from the simulation of the 100-m freestyle race. Results: It was identified time effect for the 100-m freestyle performance (p < 0.001). Conclusion: It was concluded that two weeks of tapering were enough for the enhancement of 100-m freestyle performance.

Prediction and Management for Relapse of Type 1 Autoimmune Pancreatitis After Initial Steroid Treatment: A Long-Term Follow-up From China.

This study aimed to investigate the frequency, predictors, and management of relapse of type 1 autoimmune pancreatitis (AIP) after steroid treatment. One hundred one patients with type 1 AIP receiving steroid as initial treatment were enrolled. Predictors were identified by multivariate analysis using Cox proportional hazards model. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated. Thirty-nine (41.1%) patients experienced relapse after steroid treatment during a median follow-up of 40 months. The cumulative rate of relapse reached a plateau at 57.6% (95% CI, 50.3%-64.9%) at 59 months. Without maintenance therapy (HR, 4.53; 95% CI, 1.35-15.17) and proximal bile duct involvement (HR, 2.10; 95% CI, 1.07-4.14) were identified as risk factors. Repeated steroid treatment with the same initial dose but longer induction and tapering duration was given to 87.2% patients with relapse and obtained response (97.1%) during a short-term follow-up (median, 19 months). Relapses are common in type 1 AIP after steroid treatment. Without maintenance therapy and proximal bile duct involvement were risk factors. Repeated steroid treatment with longer duration is effective for relapse.

Systems model and individual simulations of training strategies in elite short-track speed skaters

ABSTRACTThis study aimed to evaluate the effect of simulated training strategies on performance potential in elite short-track speed skaters. Training load and field-based criterion performances from fifteen athletes (10 males, 5 females) were collected over a 3-month training period and the relationship between training loads and performance was computed with a variable dose-response model using a genetic algorithm. Individual simulations of tapers preceded or not preceded by an overload training (OT) were assessed. We obtained a significant correlation between actual and modelled performances (R2 = 0.76 ± 0.07). Regarding model parameters, no significant difference was found between males and females but the time to recover performance tended to be lower in females. Simulations in which the taper parameters were free highlighted that an exponential or a step taper were the most effective for increasing performance compared to a linear taper (p < 0.05). Optimal exponential taper duration after OT was 10.7 ± 2.4d and the optimal load reduction was 75.9 ± 3.7%. OT intensity had the greatest influence on the predicted performance, followed by OT duration, taper decay, and to a lesser extent load reduction during taper and taper duration. Thus, a variable dose-response systems model allows the evaluation of different taper strategies and their potential effect on performance changes.

Shortened Taper Duration after Implementation of a Standardized Protocol for Iatrogenic Benzodiazepine and Opioid Withdrawal in Pediatric Patients: Results of a Cohort Study.

Methadone and lorazepam prescribing discrepancies for the use of iatrogenic withdrawal were observed among providers. A standardized pharmacist-managed methadone and lorazepam taper protocol was implemented at a pediatric tertiary care facility with the aim to reduce the length of taper for patients with iatrogenic withdrawal. A multidisciplinary team of nurses, pharmacists, and physicians reviewed the current literature, then developed and implemented a standardized withdrawal taper protocol. Outcomes were compared with a retrospective control group using past prescribing practices. The primary endpoint was the length of methadone and/or lorazepam taper. Secondary endpoints included evaluation for significant differences between the control and standardized protocol groups regarding additional breakthrough withdrawal medications, pediatric intensive care unit (PICU) and hospital length of stay. We also evaluated provider satisfaction with the protocol. The standardized protocol group included 25 patients who received methadone and/or lorazepam taper. A retrospective control group contained 24 patients. Median methadone taper length before protocol implementation was 9.5 days with an interquartile range (IQR) of 5.5-14.5 days; after protocol implementation, it was 6.0 (IQR, 3.0-9.0) days (P = 0.0145). Median lorazepam taper length before protocol implementation was 13.0 (IQR, 8.0-18.0) days; after protocol implementation, it was 6.0 (4.0-7.0) days (P = 0.0006). A statistical difference between PICU length of stay, hospital length of stay, or the number of additional medications for breakthrough withdrawal was not found. The use of a standardized withdrawal protocol resulted in shorter taper duration for both the methadone and lorazepam groups. There was no difference in PICU or hospital length of stay.

Antidepressant tapering strips to help people come off medication more safely

ABSTRACT Antidepressants are commonly prescribed for many mental disorders, including psychosis. Withdrawal effects, resulting from inappropriately short duration of tapering or lack of flexibility in prescribing gradual reduction, are common. An observational study was conducted of the use of “tapering strips”, which allow gradual dosage reduction and minimise the potential for withdrawal effects. A tapering strip consists of antidepressant medication, packaged in a roll of small daily pouches, each with the same or slightly lower dose than the one before it. Strips come in series covering 28 days. Of 1194 users of tapering strips, 895 (75%) wished to discontinue their antidepressant medication. In these 895, median length of antidepressant use was 2–5 years (IQR: 1–2 years– > 10 years). Nearly two-thirds (62%) had unsuccessfully attempted withdrawal before (median = 2 times before, IQR 1–3). Almost all of these (97%) had experienced some degree of withdrawal, with 49% experiencing severe withdrawal (7 on a scale of 1–7, IQR 6–7). The most common medications were paroxetine (n = 423, 47%) and venlafaxine (n = 386, 43%). Of the 895 wishing to discontinue, 636 (71%) succeeded in tapering their antidepressant medication completely, using a median of 2 tapering strips (IQR 1–3) over a median of 56 days (IQR = 28–84). Tapering strips represent a simple and effective method of achieving a gradual dosage reduction.

Assessment of outcomes following high-dose opioid tapering in a Veterans Healthcare System.

To assess the impact of tapering of chronic high dose opioid therapy in veterans prompted by the implementation of the Opioid Safety Initiative in 2013. IRB and VA Office of Research and Development-approved retrospective, observational chart review. North Florida/South Georgia Veterans Health System Patients: Veterans on high dose opioid therapy (≥300 mg of morphine equivalents per day) for chronic non-cancer pain as of 1/1/2012 with an opioid agreement discontinuation note documented in the medical record were included. Veterans treated for cancer pain or under palliative care were excluded. Descriptive outcomes include rate of opioid discontinuation, average duration of tapering, and rate of relapse. Differences before and after discontinuation assessed include healthcare utilization, monitoring via urine drug screens and state prescription drug monitoring program (PDMP) queries, non-opioid analgesics, benzodiazepines, and non-pharmacologic modalities. Forty-three patients were included. The mean duration of therapy was 7.8 years and 81.4 percent were on methadone prior to tapering. Opioids were tapered to discontinuation in 28 patients (65 percent) with long-term abstinence in 71 percent. The mean duration of tapering was 81 days and the median/mode was 30 days. Statistically significant differences after tapering include decreased PDMP queries, increased non-opioid analgesics, decreased benzodiazepine prescriptions, and increased use of mental health services (p < 0.05). There were zero adverse outcomes identified in those tapered and one death in the group who sought non-VA care for continuation. This study suggests that moderate speed tapering in high-risk veterans on chronic high-dose opioid therapy can be achieved, but caution is warranted in ensuring adequate follow-up and monitoring. Clinical pharmacy services may improve tapering outcomes by providing more frequent follow-up, monitoring via state PDMP queries to identify patients who have relapsed, and dispensing naloxone for increased safety.

Safety of resuming anti-PD-1 in patients with immune-related adverse events (irAEs) during combined anti-CTLA-4 and anti-PD1 in metastatic melanoma

Combined cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed death 1 (PD-1) blockade induces high rates of immune-related adverse events (irAEs). The safety of resuming anti-PD-1 in patients who discontinue combination therapy due to irAEs is not known. We assessed patients who experienced clinically significant irAEs from combined CTLA-4 and PD-1 blockade leading to treatment discontinuation at four academic centers. We assessed the safety of resuming anti-PD-1 in terms of recurrent and distinct irAEs. Eighty patients discontinued combination therapy due to irAEs, including colitis (41%), hepatitis (36%), and pneumonitis (4%). Of these, 96% received corticosteroids and 21% received additional immunosuppression (e.g. infliximab). All were rechallenged with anti-PD-1, and 14 (18%) had recurrent irAEs at a median of 14 days after therapy resumption (six grade 1-2, seven grade 3-4, and one grade 5 Steven-Johnson Syndrome). Colitis was less likely to recur than other irAEs (6% versus 28%, P = 0.01). Clinically significant but distinct toxicities occurred in an additional 17 (21%) patients (11 grade 1-2 and 6 grade 3-4). Duration of steroid taper, severity of initial irAEs and use of additional immunosuppressants did not predict for toxicity on rechallenge, although patients remaining on steroid therapy at anti-PD-1 resumption had higher rates of toxicities (55% versus 31%, P = 0.03). Patients who discontinued CTLA-4/PD-1 blockade for severe irAEs had relatively high rates of recurrent or distinct toxicities with anti-PD-1 resumption. However, many patients, particularly with combination-induced colitis, tolerated anti-PD-1 rechallenge well, and this approach can be considered in selected patients.

Effect of tapering after a period of high-volume sprint interval training on running performance and muscular adaptations in moderately trained runners.

The effect of tapering following a period of high-volume sprint interval training (SIT) and a basic volume of aerobic training on performance and muscle adaptations in moderately trained runners was examined. Eleven (8 men, 3 women) runners [maximum oxygen uptake (V̇o2max): 56.8 ± 2.9 ml·min-1·kg-1; mean ± SD] conducted high-volume SIT (HV; 20 SIT sessions; 8-12 × 30 s all-out) for 40 days followed by 18 days of tapering (TAP; 4 SIT sessions; 4 × 30 s all-out). Before and after HV as well as midway through and at the end of TAP, the subjects completed a 10-km running test and a repeated running test at 90% of vV̇o2max to exhaustion (RRT). In addition, a biopsy from the vastus lateralis muscle was obtained at rest. Performance during RRT was better ( P < 0.01) at the end of TAP than before HV (6.8 ± 0.5 vs. 5.6 ± 0.5 min; means ± SE), and 10-km performance was 2.7% better ( P < 0.05) midway through (40.7 ± 0.7 min) and at the end of (40.7 ± 0.6 min) TAP than after HV (41.8 ± 0.9 min). The expression of muscle Na+-K+-ATPase (NKA)α1, NKAβ1, phospholemman (FXYD1), and sarcoplasmic reticulum calcium transport ATPase (SERCA1) increased ( P < 0.05) during HV and remained higher during TAP. In addition, oxygen uptake at 60% of vV̇o2max was lower ( P < 0.05) at the end of TAP than before and after HV. Thus short-duration exercise capacity and running economy were better than before the HV period together with higher expression of muscle proteins related to Na+/K+ transport and Ca2+ reuptake, while 10-km performance was not significantly improved by the combination of HV and tapering. NEW & NOTEWORTHY Short-duration performance became better after 18 days of tapering from ~6 wk of high-volume sprint interval training (SIT), whereas 10-km performance was not significantly affected by the combination of high-volume SIT and tapering. Higher expression of muscle NKAα1, NKAβ1, FXYD1, and SERCA1 may reflect faster Na+/K+ transport and Ca2+ reuptake that could explain the better short-duration performance. These results suggest that the type of competition should determine the duration of tapering to optimize performance.

A randomized controlled trial of buprenorphine taper duration among opioid-dependent adolescents and young adults.

Few randomized controlled trials have evaluated buprenorphine treatment interventions for opioid-dependent youth. Consequently, optimal administration strategies for this cohort are unclear. Our aim was to evaluate the relative efficacy of two different buprenorphine taper lengths in promoting abstinence from illicit opioids and treatment retention among opioid-dependent youth. A double-blind, placebo controlled, multicenter randomized controlled trial. Two hospital-based research clinics (Manhattan and Brooklyn) in New York City, USA from 2005 to 2010. Volunteer sample of 53 primarily Caucasian participants between the ages of 16 and 24 (n=11 under age 18) who met DSM-IV opioid dependence criteria. Participants were assigned randomly to either a 28-day buprenorphine taper (n=28) or 56-day buprenorphine taper (n=25) via a parallel-groups design during a 63-day period. Both groups received behavioral counseling and opioid abstinence incentives. Both taper conditions had a minimum of 1week of placebo dosing at the end of the taper. The primary outcome was opioid abstinence measured as a percentage of scheduled urine toxicology tests documented to be negative for opioids. The secondary outcome was treatment retention, measured as number of days attended scheduled visits. Intent-to-treat analyses revealed that participants who received a 56-day buprenorphine taper had a significantly higher percentage of opioid-negative scheduled urine tests compared with participants who received a 28-day buprenorphine taper [35 versus 17%, P=0.039; Cohen's d=0.57, 95% confidence interval (CI)=0.02, 1.13]. Participants who received a 56-day buprenorphine taper were retained in treatment significantly longer than participants who received a 28-day buprenorphine taper (37.5 versus 26.4days, P=0.027; Cohen's d=0.63, 95% CI=0.06, 1.19). Daily attendance requirement was associated with decreased abstinence and shorter retention compared with a two to three times weekly attendance requirement, independent of taper duration. Follow-up data were insufficient to report. Longer (56-day) buprenorphine taper produces better opioid abstinence and retention outcomes than shorter (28-day) buprenorphine taper for opioid-dependent youth.

Yearly reduction of glucocorticoid dose by 50% as tapering schedule achieves complete remission for 124 pemphigus vulgaris patients

Glucocorticoids are the first-line treatment for pemphigus vulgaris. Among 140 patients receiving systemic glucocorticoids, 124 patients achieved complete remission off or on a prednisone dose of ≤10 mg/day or less for 6 months or more. The mean average steroid controlling doses were 0.65, 0.62, 0.80, 1.08 and 1.38 mg/kg per day for the mucosal-dominant patients and the mild, moderate, severe and extensive cutaneous-involved patients, respectively (P < 0.001). The mean durations of the initial tapering after controlling doses started were 77.98, 48.78, 31.74 and 28.83 days when the disease was controlled with doses of 40 mg/day or less, 45-60 mg/day, 65-80 mg/day and more than 80 mg/day for the cutaneous-involved types, respectively (P < 0.005). Of the patients, 79.51% achieved complete remission within 3 years, 98.36% within 5 years and all within 6 years, which corresponded to a 50% yearly reduction of glucocorticoid dose. These successfully treated patients indicate that a severity-tailored initial dose of glucocorticoids, an initial tapering duration based on the initial dose and a subsequent 50% yearly tapering regimen may cure pemphigus vulgaris within 3-6 years.

What do epileptologists recommend about discontinuing antiepileptic drugs for a second time in children?

ObjectiveThere is a broad consensus that antiepileptic drugs (AEDs) may be withdrawn after two years of seizure freedom for most children with epilepsy. If seizures recur and are, again, completely controlled with AEDs, little is known about discontinuing a second time. We surveyed American and Canadian pediatric epileptologists to understand their current practice. MethodsIn 2014, a survey was sent via e-mail to 193 pediatric epileptologists to learn about AED discontinuation practices in children. The survey asked direct questions about practice and posed five “real-life” cases where the decision to discontinue might be difficult. Participants were identified through membership lists of several US and Canadian epilepsy organizations. ResultsThere were 94 (49%) completed surveys. Sixty-three participants had ≥10years in practice (“more experienced”: mean 23±9years), and 31 had <10years (“less experienced”: mean 6±2). Overall, 62% recommended AED discontinuation for the first time after 2–3years of seizure freedom, and 61% recommended discontinuation for the second time after 2–3years. Fifty-six percent of “more experienced” clinicians required a longer seizure-free period prior to a second discontinuation (p<0.001) compared with 26% of “less experienced” clinicians (p=ns). Overall, most participants suggested an AED taper duration of 2–6months for the first and second attempts, 52% and 68%, respectively. Both groups wean AEDs more slowly during the second attempt (p<0.001). There was only 40–60% agreement among participants to discontinue AEDs in four of the cases. ConclusionNearly half (46%) of pediatric epileptologists require a longer seizure-free period the second time they attempt to discontinue AEDs compared with the first attempt and wean down AEDs somewhat more slowly. Although a variety of factors influence decision-making, there was a high level of disagreement to discontinue AEDs a second time in “real-life” cases.

Tapering strategies in elite British endurance runners

The aim of the study was to explore pre-competition training practices of elite endurance runners. Training details from elite British middle distance (MD; 800 m and 1500 m), long distance (LD; 3000 m steeplechase to 10,000 m) and marathon (MAR) runners were collected by survey for 7 days in a regular training (RT) phase and throughout a pre-competition taper. Taper duration was [median (interquartile range)] 6 (3) days in MD, 6 (1) days in LD and 14 (8) days in MAR runners. Continuous running volume was reduced to 70 (16)%, 71 (24)% and 53 (12)% of regular levels in MD, LD and MAR runners, respectively (P < 0.05). Interval running volume was reduced compared to regular training (MD; 53 (45)%, LD; 67 (23)%, MAR; 64 (34)%, P < 0.05). During tapering, the peak interval training intensity was above race speed in LD and MAR runners (112 (27)% and 114 (3)%, respectively, P < 0.05), but not different in MD (100 (2)%). Higher weekly continuous running volume and frequency in RT were associated with greater corresponding reductions during the taper (R = −0.70 and R = −0.63, respectively, both P < 0.05). Running intensity during RT was positively associated with taper running intensity (continuous intensity; R = 0.97 and interval intensity; R = 0.81, both P < 0.05). Algorithms were generated to predict and potentially prescribe taper content based on the RT of elite runners. In conclusion, training undertaken prior to the taper in elite endurance runners is predictive of the tapering strategy implemented before competition.

A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers

Although abuse of prescription opioids (POs) is a significant public health problem, few experimental studies have investigated the treatment needs of this growing population. To evaluate, following brief stabilization with a combination of buprenorphine hydrochloride and naloxone hydrochloride dihydrate, the relative efficacy of 1-, 2-, and 4-week buprenorphine tapering regimens and subsequent naltrexone hydrochloride therapy in PO-dependent outpatients. A double-blind, 12-week randomized clinical trial was conducted in an outpatient research clinic. Following a brief period of buprenorphine stabilization, 70 PO-dependent adults were randomized to receive 1-, 2-, or 4-week tapers followed by naltrexone therapy. During phase 1 (weeks 1-5 after randomization), participants visited the clinic daily; during phase 2 (weeks 6-12), visits were reduced to thrice weekly. Participants received behavioral therapy and urine toxicology testing throughout the trial. The percentage of participants negative for illicit opioid use, retention, naltrexone ingestion, and favorable treatment response (ie, retained in treatment, opioid abstinent, and receiving naltrexone at the end of the study). Opioid abstinence at the end of phase 1 was greater in the 4-week compared with the 2- and 1-week taper conditions (P = .02), with 63% (n = 14), 29% (n = 7), and 29% (n = 7) of participants abstinent in the 4-, 2-, and 1-week conditions, respectively. Abstinence at the end of phase 2 was also greater in the 4-week compared with the 2- and 1-week conditions (P = .03), with 50% (n = 11), 16% (n = 4), and 20% (n = 5) of participants abstinent in the 4-, 2-, and 1-week conditions, respectively. There were more treatment responders in the 4-week condition (P = .03), with 50% (n = 11), 17% (n = 4), and 21% (n = 5) of participants in the 4-, 2-, and 1-week groups considered responders at the end of treatment, respectively. Retention and naltrexone ingestion also were superior in the 4-week vs briefer tapers (both P = .04). Experimental condition (ie, taper duration) was the strongest predictor of treatment response, followed by buprenorphine stabilization dose. This study represents a rigorous experimental evaluation of outpatient buprenorphine stabilization, brief taper, and naltrexone maintenance for treatment of PO dependence. Results suggest that a meaningful subset of PO-dependent outpatients may respond positively to a 4-week taper plus naltrexone maintenance intervention.

Effects and Mechanisms of Tapering in Maximizing Muscular Power

Muscle power is of great importance in most sports, and its development is one of the most fundamental physiological adaptations for improving physical performance. In order to optimize competition performance, athletes usually decrease training load before competition, the so-called tapering, to allow physiological and psychological recovery from accumulated training stress. Tapering could be conducted through changes in training volume, intensity and/or frequency, but training volume seems to be most effective in optimizing muscular power. There are two main types of tapering: progressive tapering and one-step tapering. Currently, there is no general conclusion on tapering duration. The physiological mechanisms regarding tapering effects on neuromuscular system are largely unknown. Generally, it is believed that sustained maximal muscular power after tapering is obtained through maintaining adaptations in muscle fiber size, fiber type and neural adaptations whereas increased maximal muscular power after tapering is assumed mainly through both physiological and psychological recovery. We believe that increased maximal muscular power after tapering may also rely on higher neural drive and increased muscle fiber cross sectional area (CSA), especially in type IIA muscle fibers. Complete rest is a special form of tapering and it usually only leads to sustained maximal power. This effect is believed to be associated with decreased muscle CSA and a transformation of muscle fibers from type IIA to type IIX.

Treating anxiety by discontinuing antidepressants: A case series

When a patient has symptoms of anxiety, while taking an antidepressant for depression, is it possible that the antidepressant is part of the problem? Can antidepressants cause anxiety? If this were so, even if relatively rare, it would have widespread implications because of the broad use of antidepressants. However, antidepressants are widely used as a treatment for anxiety. Therefore, unless suggestive evidence were to emerge to implicate them as a potential exacerbating factor, broad use of antidepressants would likely continue for patients whose depression has improved but whose anxiety has not responded, or worsened. In that context we present 12 patients whose anxiety diminished substantially when antidepressants were tapered off, as reflected in Clinical Global Improvement Scale scores assigned by their respective clinicians. Mean duration of antidepressant taper was 17weeks (range 0–48), as suggested by limited prior evidence supporting very slow taper rates for this purpose. Alternative treatments for depression were often used for these patients as antidepressants were tapered, particularly lithium and lamotrigine, but none of the alternatives used are generally regarded as having anti-anxiety effects. Patients with bipolar disorder diagnoses, including schizoaffective disorder, were specifically excluded. In many of these cases, other medications that might have anti-anxiety effects (including buspirone, quetiapine, olanzapine, gabapentin, and diphenhydramine) were also tapered off. Results suggest that antidepressants may actually cause anxiety in some patients with unipolar depression. Alternatively, lamotrigine or lithium may have more anti-anxiety effects than generally recognized; or these patients may have had subtle bipolar disorder despite the absence of symptoms meeting formal criteria, supporting the “bipolar spectrum” perspective on mood disorder diagnosis. This study is limited by the outcome measure used, which assesses anxiety only indirectly in the context of global improvement. However, in view of the broad implications of the findings, these preliminary observations warrant further consideration. Some patients with anxiety may be treatable not by adding medications, but rather by tapering off existing ones.

A pilot study assessing the frequency and complexity of methadone tapers for opioid abstinence syndrome in children discharged to home

BackgroundMethadone is often prescribed as a taper schedule to prevent/treat opioid abstinence syndrome (OAS) or neonatal abstinence syndrome (NAS). ObjectiveThe objective of this study was to determine the percentage of children discharged home on methadone tapers and to develop, assess, and implement an instrument for measuring the complexity of the methadone regimens. MethodsThis study used a descriptive retrospective design to examine patients younger than 18 years from January 1, 2008, to December 31, 2008, administered methadone for prevention/treatment of OAS/NAS and discharged home on a methadone taper. Data collection included demographics and characteristics of methadone regimen. The primary objective was to determine the percentage of children discharged on methadone. Secondary objectives included characterization (ie, number of dosage and interval changes), duration, and complexity of the methadone taper. Descriptive statistics were performed using Stata v10 (StataCorp LP, College Station, TX). Complexity was evaluated using the medication taper complexity score (MTCS) between 4 raters. Reliability of the MTCS was established using interrater correlation analyses of the regimen complexity scores. ResultsThirty-three patients (41.8%) were discharged on methadone. The median (range) age was 0.42 (0-12) years, with most patients (75.8%) initiated on methadone for prevention of OAS. Thirty-one patients were included for further analysis of medication complexity. The median (range) duration of the home taper was 8 days (2-48), which included a median (range) of 4 (1-11) dose changes and at least 1 (0-2) change in the interval. MTCS ranged from 7 to 42, with the tool demonstrating 95% interrater reliability. ConclusionsMore than one-third of patients were discharged home on methadone. The median taper duration was 8 days and included a median of 5 adjustments in either the dose or interval. The MTCS demonstrated very good interrater reliability to measure wide variability in the complexity of individual tapers. Future studies should determine the construct validity of the MTCS and the applicability of this tool for further research and clinical application.

Duration of Corticosteroid Tapering as First Line Treatment In Idiopathic Thrombocytopenic Purpura.

AbstractAbstract 3688 Background:Idiopathic Thrombocytopenic Purpura (ITP) is a relatively common benign hematologic disorder. Management of ITP is difficult as many treatment regimens present risks that may pose more harm than the disease itself. Typically, corticosteroid is used as first line treatment, but there is currently no evidence-based guideline to direct the optimal duration of therapy. Objective:To investigate the effectiveness and relative safety of various lengths of corticosteroid therapy. Methods:In a retrospective cohort study, charts of all ITP patients seen in the general hematology clinic at the London Health Sciences Centre (LHSC) from January 1, 2004 to December 31, 2009 were reviewed. Results: A total of 312 patients with ITP were reviewed. 128 of the patients (52 male, 76 female), age range 4–94 at time of diagnosis, required corticosteroid treatment. Of those, 35 patients were treated with short term steroid regimen (< 8 weeks); 32 patients had 8–16 weeks of therapy, and 64 patients received long term steroid tapering regimen (>16 weeks). Based on results, 63%, 56% and 39% of patients achieved complete response in each group respectively. The follow-up duration from diagnosis ranged from 1 month to 29 years (with median of 1 year).Duration of Corticosteroid Therapy< 8 weeks n = 358–16 weeks n = 32> 16 weeks n = 64Complete Response22 (63%)18 (56%)25 (39%)Partial Response7 (20%)7 (22%)9 (14%)No Response6 (17%)7 (22%)30 (47%)Relapse after Response12 (41%)8 (32%)17 (50%)Side Effects13 (37%)13 (41%)26 (41%)Interestingly, the same proportion of patients experienced side effects as a result of steroid use in all groups. However, frequency of serious complications such as avascular necrosis and infections, occurred at a higher rate in the long term therapy group (9%) compared to 0% in short term therapy group. Conclusions:Rapid corticosteroid taper is as effective as a slow corticosteroid taper and has less serious side effects. Disclosures:No relevant conflicts of interest to declare.

Variability in Duration of Outpatient Diuretic Therapy in Bronchopulmonary Dysplasia: A Clinical Experience

We describe usual duration of outpatient diuretic therapy and duration of tapering of outpatient diuretics in infants with established bronchopulmonary dysplasia (BPD), and we identify factors associated with duration of diuretic taper. Infants with BPD discharged from the neonatal intensive care unit on diuretic therapy were identified and data were abstracted from clinical databases and medical records. BPD was defined as oxygen dependence at 28 days of life. Infants with chromosomal abnormalities or congenital heart disease and those requiring tracheostomy placement were excluded. Descriptive, univariate, and multivariate analyses were performed. Of 59 patients discharged on diuretic therapy, 10 were also discharged on oxygen. Median (25th, 75th percentiles) duration of outpatient diuretic therapy was 94 (69, 115) days and 30 (14, 84) days for duration of diuretic taper. Duration of therapy and duration of taper were significantly longer in infants discharged on oxygen. In Cox proportional hazards modeling, longer diuretic taper was associated with a higher dose of chlorothiazide at discharge, shorter interval to first outpatient visit, need for rehospitalization, and African-American race. Birth weight, gestational age, and various discharge therapies were not significantly associated with duration of taper after adjusting for these factors. In 58% of all patients, diuretics were tapered or discontinued at the first outpatient visit. This study demonstrated great variability in the duration of diuretic therapy and diuretic taper. Discharge on oxygen was associated with longer duration of diuretic therapy and taper. Active taper is successful in the majority of patients and should be considered in patients with stable BPD.