Efficacy Of Corticosteroids Research Articles

Antenatal Corticosteroids at 21-23 Weeks of Gestation.

Neonates born at the cusp of viability are at particularly high risk of severe morbidity and mortality. With advances in medicine and technology, the ability to resuscitate smaller, more premature neonates has become possible, and survival as early as 21 weeks of gestation has been reported. Although administration of antenatal corticosteroids has been shown to reduce the risk of morbidity and mortality at later gestational ages, neonates born before 24 weeks of gestation have not been included in randomized clinical trials. Changing clinical practices surrounding neonatal resuscitation with intervention offered after birth at earlier gestational ages has prompted re-evaluation of the use of antenatal corticosteroids at these very early gestational ages. Recent observational data demonstrate that antenatal corticosteroids administered before deliveries at or after 22 weeks of gestation are associated with lower risks of neonatal mortality, although survival with severe morbidity remains high. Future research is needed to determine the efficacy of antenatal corticosteroids for deliveries before 22 weeks of gestation and should evaluate the timing of corticosteroid administration. Furthermore, efforts should be made to include diverse populations and clinically meaningful long-term outcomes. At this time, the decision surrounding antenatal corticosteroids for threatened periviable deliveries should incorporate multidisciplinary counseling with the goal of achieving concordant prenatal and postnatal management aligned with the patient's desires.

Systemic treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials

BackgroundAtopic dermatitis (AD) is an inflammatory skin condition with multiple systemic treatments and uncertainty regarding their comparative impact on AD outcomes. ObjectiveWe systematic synthesized the benefits and harms of AD systemic treatments. MethodsFor the 2023 AAAAI/ACAAI JTFPP AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT, from inception to November 29, 2022, for randomized trials addressing systemic treatments and phototherapy for AD. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-quality of life, flares, and harms. The GRADE approach informed certainty of evidence ratings. OSF: https://osf.io/e5sna. Results149 included trials (28,686 patients with moderate-to-severe AD) evaluated 75 interventions. With high-certainty, high-dose upadacitinib was among the most effective for five of six patient-important outcomes; high-dose abrocitinib and low-dose upadacitinib were among the most effective for two outcomes. These JAK inhibitors were among the most harmful in increasing adverse events. With high-certainty, dupilumab, lebrikizumab, and tralokinumab were of intermediate effectiveness and among the safest—modestly increasing conjunctivitis. Low-dose baricitinib was among the least effective. The efficacy and safety of azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy, and many novel agents are less certain. ConclusionsAmong individuals with moderate-to-severe AD, high-certainty evidence demonstrates that high-dose upadacitinib is among the most effective in addressing multiple patient-important outcomes but also among the most harmful. High-dose abrocitinib and low-dose upadacitinib are effective, but also among the most harmful. Dupilumab, lebrikizumab, and tralokinumab are of intermediate effectiveness and favorable safety.

Antenatal corticosteroids in specific groups at risk of preterm birth: a systematic review

ObjectiveThis study aimed to synthesise available evidence on the efficacy of antenatal corticosteroid (ACS) therapy among women at risk of imminent preterm birth with pregestational/gestational diabetes, chorioamnionitis or fetal growth...

42227 Efficacy and Predictive Factors of Systemic Corticosteroid in Alopecia Areata: Reappraisal of Oral Methylprednisolone Tapering Treatment

42227 Efficacy and Predictive Factors of Systemic Corticosteroid in Alopecia Areata: Reappraisal of Oral Methylprednisolone Tapering Treatment

The Efficacy of Corticosteroids in the Management of Tietze Syndrome: A Randomized Controlled Trial

Abstract Background So far there are no clinical trials in the literature discussing the methods of treatment of Tietze‟s syndrome. Particularly, conservative methods of treatment are used, which include pain management using analgesics and nonsteroidal anti-inflammatory drugs. Oral corticosteroids offer a safe and effective treatment modality that is proven to be useful in a significant number of chest wall syndromes such as Sternoclavicular arthritis, Painful xiphoid syndrome, Costovertebral arthritis, and Slipping rib syndrome as well as conditions arising from ligament and tendon diathesis. Objective To use oral Corticosteroids in management of patients with Tietze syndrome at Ain shams university hospitals‟ cardiothoracic department and measuring the outcome randomly compared with the conventional NSAIDs to achieve the best outcome and quality of life. Methods This study included 40 patients who were diagnosed clinically as Tietze Syndrome at Ain Shams University Hospitals-cardiothoracic department in the duration between August 2020 till March 2022 with age ranging from 14 to 45 years and were sorted randomly. Two groups of patients were chosen and matched randomly as „Control arm‟ and „Interventional arm‟. The control group received the conventional NSAIDs (in the form of 50 mg of diclofenac potassium as „cataflam‟ twice daily) and the Interventional group received oral corticosteroids (in the form of 20 mg of prednisolone as „solupred‟ twice daily). Results Our study suggested that in patients with moderate to severe chondritis diagnosed clinically as Tietze syndrome, a 3 week course of oral 40 mg prednisolone is superior to the conventional oral NSAIDs in alleviating pain and improving the quality of life which is evidenced by the decline in EQ-5D total score of patients receiving oral steroids at the end of the treatment course as well as during each week throughout the trial timeframe. A highly significant reduction in pain score demonstrated via NRS was evident in the steroid-treated group compared to the NSAIDs-treated group at the same time point. Conclusion Oral corticosteroids are effective and safe in non-responding, obstinate Tietze syndrome. The results were unexpectedly good, obtaining significant relief and an outstanding refinement in quality of life reported by patients receiving oral steoids. There is no widely accepted protocol for oral steroid usage in Tietze syndrome and similar chest wall pain syndromes. Some other studies propose surgery in such patients. We think that surgery is a troublesome intervention for the patient and his doctor as well.

Efficacy of corticosteroids on postoperative pain levels after nonsurgical endodontic treatment: An overview of systematic reviews

Introduction: According to previously published data, the severity of pain caused by pulp therapy and root canal treatment is more compared to other dental operative procedures. Corticosteroids are one of the most common drugs used in endodontics for reducing postoperative pain levels. The aim of this study is to compare and assess the effect of corticosteroids on postoperative pain levels with an active or passive placebo after nonsurgical endodontic treatment. Materials and Methods: The standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used for framing the review protocol and it was then registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022372527). In this overview, systematic reviews with or without meta-analysis that evaluated the efficacy of corticosteroids alone, irrespective of their route, time, dosage of administration, and tooth vitality, in controlling postoperative pain levels in teeth requiring root canal treatment were included. The assessment of multiple systematic reviews tool was used to investigate the methodological quality of the systematic reviews included in this review. Results: The majority of the studies that were selected for this review showed that using corticosteroids led to a significant decrease in pain levels following endodontic treatment, especially at 6 h after completion of treatment. Pain levels were reduced considerably when prednisolone was compared with other forms of corticosteroids. It is suggested that when prednisolone is administered 30 min before the commencement of root canal therapy, it is similar in its effect to using similar doses for a longer duration. However, further randomized controlled trials are required keeping the strict inclusion criteria in mind. Conclusions: The systematic reviews summarized in this overview support the conclusion that using corticosteroids greatly reduced postoperative pain following endodontic treatment, and they also dispel any misconceptions about corticosteroids’ routine use in moderation.

CORTICOSTEROID THERAPY FOR PATIENTS HOSPITALIZED WITH COMMUNITY-ACQUIRED PNEUMONIA : A SYSTEMATIC REVIEW

Introduction: Pneumonia is an inflammation of the lung parenchyma in the distal terminal bronchioles, which includes the respiratory bronchioles and alveoli. Corticosteroids are routinely used for severe pneumonia symptoms. Numerous studies on adjuvant corticosteroids for community-acquired pneumonia (CAP) have yielded equivocal results. Several systematic reviews and meta-analyses have studied the efficacy of corticosteroids in treating CAP. 
 The aim: This article showed about corticosteroid therapy for patients hospitalized with community-acquired pneumonia (CAP).
 Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done.
 Result: The PubMed database yielded a total of 423 articles in response to our search query, while the search conducted on SagePub retrieved 491 articles. The search run for the last year of 2013 generated a total of 223 articles from PubMed and 212 articles from SagePub. Ultimately, a cumulative sum of 21 scholarly articles was assembled, with 15 originating from the PubMed database and the other six sourced from SagePub. We have incorporated four studies that satisfied the specified criteria.
 Conclusion: Administration of steroids as early as possible in patients with severe CAP who are treated to benefit, where they do not experience therapy failure. Slower administration and inadequate doses do not provide any benefit.

Efficacy of Additional Corticosteroids After Dexamethasone Treatment for Moderate to Severe COVID-19: An Observational Study.

Background Previous studies have demonstrated dexamethasone (DEX)'s efficacy for coronavirus disease 2019 (COVID-19). In contrast, patients with residual lung field shading and symptoms after DEX treatment have been observed, and the efficacy of additional corticosteroids (AC) is unknown. Objectives We aimed to investigate the efficacy of AC in patients with COVID-19 with residual respiratory symptoms or who required oxygen therapy or invasive mechanical ventilation after DEX treatment. Methods This was a single-center, retrospective observational study including 261 patients with community-onset COVID-19, aged ≥ 18 years, admitted to our hospital between March 1, 2020, and May 31, 2021. Finally, 34 patients were included in the study who met all four of the following criteria: (1) required oxygen therapy or invasive ventilation, (2) were treated with DEX, (3) had residual shading on chest imaging after DEX treatment, or (4) had unimproved respiratory symptoms or oxygen saturation < 90%. We reviewed the medical records and clinical courses of 14 patients who received ACtherapy (AC group) and 20 patients who did not (non-additional corticosteroids or NC group). Results The 90-day mortality rate was 35.7% in the AC group and 25.0% in the NC group. There was no statistically significant difference between the two groups (p = 0.797). In addition, there was no difference between groups in the proportion of patients who required oxygen therapy at discharge (64% vs. 35%, p = 0.162). The time from the end of DEX therapy to discharge was significantly longer in the AC group (median 7.5 vs. 33 days, p = 0.019). Regarding serious adverse events, infection was statistically more common in the AC group than in the NC group (p = 0.005). Conclusions ACafter DEX treatment does not improve clinical outcomes and may prolong hospital stay.

THE EFFICACY OF CORTICOSTEROID AFTER FACIAL NERVE NEURORRHAPHY: A SYSTEMATIC REVIEW

Background: In case of comple transection of facial nerve, it is unclear whether or not corticosteroids will be beneficial after facial nerve neurorrhaphy.&#x0D; Aim: The purpose of this systematic review was to determine whether or not corticosteroids are effective in promoting facial nerve regeneration and functional recovery following complete transection and neurorrhaphy.&#x0D; Methods: Randomized controlled trials on human and animal models from Ovid MEDLINE and Ovid EMBASE that studied the efficacy of corticosteroids in total facial nerve damage followed by neurorrhaphy. Electrophysiology, histology, and functional recovery were the methods that were used to evaluate the results. On the other hand, there was no randomised controlled experiment carried out on humans. In a clinical context, it's possible that it won't be possible to conduct human trials that involve histology.&#x0D; Results: Six animal investigations with a total of 248 participants met the inclusion criteria. Electrophysiological results revealed no differences between systemic corticosteroids and controls in terms of latency and amplitude. The results of a comparison between topical corticosteroid and the control group revealed no differences in latency and amplitude. In histologic outcomes, there were no differences in axon diameter between the systemic corticosteroid and control groups; however, the control group had thicker myelin. Comparing systemic corticosteroid to a placebo in terms of eye blinking, the results favoured the placebo.&#x0D; Conclusion: When analysing electrophysiologic and functional recovery outcomes in animal models, this study did not demonstrate any possible benefits of systemic or topical corticosteroid administrations after facial nerve neurorrhaphy in complete transection.

The efficacy of antenatal corticosteroids to improve preterm newborn outcomes in low-resource countries: Are we there yet?

The efficacy of antenatal corticosteroids to improve preterm newborn outcomes in low-resource countries: Are we there yet?

Efficacy of Corticosteroids and Intravenous Immunoglobulins in a Patient with Toxic Epidermal Necrolysis Secondary to Sulfadoxine: A Case Report and Literature Review

Toxic epidermal necrolysis (TEN) is a rare life-threatening mucocutaneous reaction characterized by epidermal detachment. Treatment success relies on early diagnosis, rapid withdrawal of the causative drug and supportive care. However, clinical evidence for therapeutic management and specific treatment is insufficient and controversial. We describe the successful management of a TEN case secondary to sulfadoxine managed in our intensive care unit. The patient presented a generalized exanthema with mucocutaneous detachment affecting 45% of the body surface area, positive Nikolsky sign, perianal enanthema and conjunctival hyperemia. Treatment with intravenous immunoglobulins and corticosteroids was prescribed, as well as calcium folinate to prevent myelotoxicity of the causative drug. In this case, hemodialysis was dismissed due to the low efficiency of this technique in removing the triggering drug. Our case report confirms the efficacy of corticosteroids, IGIV, topical treatment on mucocutaneous lesions and supportive care for the management of TEN secondary to sulfadoxine.

Evaluating the efficacy of corticosteroids and bronchodilators in the management of paediatric bronchiolitis

Background: Bronchiolitis, a standard lower tract infection in young children, poses significant challenges in terms of diagnosis and management. Corticosteroids and bronchodilators are often prescribed to manage this condition, despite limited evidence supporting their efficacy. This study aimed to judge the effectiveness of corticosteroids and bronchodilators within the management of paediatric bronchiolitis. Objective: to see the clinical efficacy of corticosteroids and bronchodilators in improving respiratory symptoms and reducing hospitalization rates among paediatric patients with bronchiolitis. Study Settings and Sample Size: This study was conducted at different centres including Department of Paediatrics, Social Security MNCH Hospital, Dera Ghazi Khan, Punjab and Sahara Medical College Narowal, Punjab in the period from October, 2022 to March, 2023 enrolling 300 children aged 1 month to 2 years with a clinical diagnosis of bronchiolitis. Methods: Participants were randomly assigned to at least one of three treatment groups: corticosteroids (n=100), bronchodilators (n=100), or placebo (n=100). the first outcome was improvement within the Respiratory Distress Assessment Instrument (RDAI) score. Secondary outcomes included hospitalization rates, length of hospital stay, and adverse events. Results: Children within the corticosteroid group experienced a significantly greater improvement in RDAI scores compared to the placebo group (p&lt;0.001).

Long-term efficacy and safety of different corticosteroid courses plus mycophenolate mofetil for autoimmune encephalitis with neuronal surface antibodies without tumor.

To compare the efficacy and safety of different-course corticosteroids plus mycophenolate mofetil (MMF) as maintenance therapy in autoimmune encephalitis (AE) with neuronal surface antibodies (NSAbs) without tumor and explore the optimal course of corticosteroids. Fifty-five patients with definite AE without tumor were enrolled consecutively between June 2015 and November 2020 and retrospectively divided three groups according to the course of treatment with corticosteroid, i.e., a group of patients with a course of 3-6 months (Group 3-6mo), 6-12 months (Group 6-12mo), and >12 months (Group >12mo). Demographic data, clinical manifestation and ancillary tests results were recorded. The dosage and courses of corticosteroid treatment, the recovery of neurological function, the occurrence of adverse effects, and relapses were followed up. A total of 55 patients were included in the final analysis. The numbers of patients in Group 3-6 mo, Group 6-12 mo, and Group >12 mo was 14, 17, and 24, respectively. A significantly higher proportion of patients in Group >12 mo showed a decreased level of consciousness at the onset (12, 50%) than in Group 3-6 mo and Group 6-12 mo (2,14.3%; 3, 17.6%) (p = 0.033). The incidence of MRI abnormalities was significantly higher in Group 6-12 mo and Group >12 mo (10, 58.8%; 16, 66.7%) than in Group 3-6 mo (3, 21.4%) (P=0.023). Ordinal regression analysis indicated that decreased level of consciousness was associated with the course of corticosteroid (OR=3.838, 95% CI: 1.103-13.323, P=0.035). No significant difference was observed between the three groups regarding the cumulative dose of corticosteroids administered during the first three months of long-term treatment (P>0.05). Additionally, no significant difference in the cumulative dosage of corticosteroids was found between patients in Group 6-12 months and Group >12 months during the first 6 months after beginning long-term treatment. The mRS scores of the three groups were not statistically significant before and after first-line treatment or at the last follow-up. Bonferroni multiple comparison test indicated that the mRS scores of patients in Group 6-12 months and Group >12 months were not statistically significant at 3 months and 12 months after the start of long-term treatment. During the follow-up, 50 (90.9%) patients achieved satisfactory neurological function (mRS score ≤2). Five patients (9.1%) experienced a first relapse and 2 of them were overlapped with both anti-NMDA receptor and glial antibodies. The incidence of adverse effects was significantly higher in Group >12 mo (17, 70.8%) than in Group 3-6 mo (3, 21.4%) and Group 6-12 mo (5, 29.4%) (P=0.003). The beneficial effects of oral corticosteroid treatment may do not persist beyond 12 months and may even contribute to an increased incidence of adverse effects. In order to optimize the effectiveness and safety of treatment, we recommend a corticosteroid course of 3-12 months. Patients with reduced levels of consciousness may be more inclined to choose longer courses of corticosteroids for long-term treatment. Patients with an "overlapping syndrome" may require more intense immunotherapy to prevent relapse.

IMPACT OF CORTICOSTEROIDS ON PERINATAL OUTCOME

Objective: The study’s main aim was to demonstrate the efficacy of antenatal corticosteroids (betamethasone) to prevent respiratory distress syndrome (RDS) and other related complications in premature babies and to study the outcomes of neonates whose mothers received corticosteroids during the antenatal period. Methods: A total of 50 pregnant women with a risk of preterm delivery admitted to the labor ward of Prathima Institute of Medical Sciences were included in the study. It is a prospective, hospital-based, and longitudinal study. All women coming to the antenatal outpatient department of Prathima Institute of Medical Sciences who are at risk of preterm delivery were selected. The follow-up component of the study involved women identified as at high risk for premature delivery and who had received betamethasone. The neonatologist diagnosed the neonatal complications was taken as an outcome. Results: Of the 50 babies that were enrolled in the study, 27 (54%) were delivered by spontaneous vaginal delivery, 1 by assisted breech (2%), 1 by instrumental delivery (2%), and 18 (36%) were delivered by cesarean section. The occurrence of RDS among babies with low APGAR was 4 (44.44%). Only one intraventricular hemorrhage occurred among the category, with a low APGAR score (11.11%). Out of 19 cases, ten deaths were identified, and nine were alive within 24 h due to the action of steroids. Among 31 cases, two cases were death, and 29 were alive after 24 h of the duration of action of steroid. Even though mothers of all babies in this study admitted to the neonatal unit had received corticosteroids, there was still 24% mortality by 28 days. The results suggest that once admitted to NICU, having only received a single dose of corticosteroids &lt;24 h previously (as opposed to more than 24 h), gestational age &lt;34 weeks, and having any listed neonatal complications were associated with mortality by 28 days. Conclusion: Even though 50% of the neonates suffered complications, over 40% of the subjects were delivered before betamethasone could take effect. Several other factors, apart from betamethasone, influenced the outcome of neonates. The present study showed that the use of ANCS administration is the single most intervention to prevent complications of prematurity which can be done at a public health center or by a private practitioner, even in rural areas.

Comparative Study on Efficacy of Topical Application of Triamcinolone Acetonide and Curcumin in Management of Oral Lichen Planus

Introduction: Oral lichen planus (OLP) is a chronic inflammatory and immune mediated disease that affects the mucous membranes. OLP is cell-mediated, immune damage to basal keratinocytes that are recognized as being antigenically foreign or altered. Many treatment modalities have been tried since the time immemorial, steroids being the mainstay of the treatment, with more benefits than adversities, but now-a-days alternative/ herbal medicines are used keeping in view the chronicity of disease and long term treatment required to cure it. Curcuminoids, the major constituent of turmeric, has anti-inflammatory, antioxidant and anticancer properties. Natural / herbal product has minimal adversities so this can be more helpful for patients in the upcoming time. Aim: The study was conducted to compare the efficacy of conventional topical corticosteroid, triamcinolone acetonide 0.1% with 1% curcumin gel in OLP patient and to assess reduction in burning sensation, regression of size and ulcero-erosive appearance of lesion. Materials and Methods: An intervention study was conducted on 40 patients diagnosed with OLP which were divided into two groups. Group A was provided with Ointment 0.1% triamcinolone acetonide while Group B was provided with 1% curcuma longa extracts gel for local application on the affected regions The results were analysed using Students t-test,discrete (categorical) data were summarised in number (n) and percentage (%) and compared by chi-square (χ2) test. Groups were also compared by two factor (groups and periods) repeated measure (RM) analysis of variance (ANOVA). Results: Intragroup comparison showed statistically significant reduction in burning sensation, size and extension of lesion (p&lt;0.001) as well as erythema and ulceration (p&lt;0.001) in both the groups. In inter-group comparison, Group A showed reduction in burning sensation (97.3%), size and extension of lesion (100%), reduction in erosive pattern (94.7%) and reduction in ulcerative .......

Predictors of all-cause mortality in hospitalized COVID-19 patients taking corticosteroids: a multicenter retrospective cross-sectional study.

A multicenter retrospective study was performed over three months targeting 422 COVID-19 patients from six hospitals in Lebanon. Data were collected from patients' medical charts retrospectively and covered a period of one year (September 2020-August 2021). The study sample included 422 patients, predominantly males, with 59% of cases classified as severe or critical cases. Dexamethasone and methylprednisolone were the most used corticosteroids. Around 22% of the patients died during hospitalization. After adjusting for covariates, performing a polymerase chain reaction before admission increased the mortality rate by 424% compared to doing it at hospital admission (aHR 4.24, 95% CI 1.35-13.3), with 18.11 times higher mortality rate among critical cases (aHR 18.11, 95% CI 9.63-31.05). Exposure to side effects from corticosteroids increased the mortality rate by 514% compared to others (aHR 5.14, 95% CI 1.28-8.58). In particular, the mortality rate among patients having hyperglycemia dropped by 73% compared to others (aHR 0.27, 95% CI 0.06-0.98). Corticosteroids are frequently used in treating hospitalized COVID-19 patients. The all-cause mortality rate was higher among older and critical cases and lower among smokers and those treated for more than 7 days. Research exploring the safety and efficacy of corticosteroids is required to allow better in-hospital management of COVID-19 cases.

Timing of antenatal corticosteroids and survival without neurologic disabilities at 5½ years in children born before 35 weeks of gestation

The efficacy of antenatal corticosteroids for neonatal preterm complications wanes beyond 7 days after treatment. The neurodevelopmental effects of longer treatment-to-birth intervals have not been adequately evaluated. This study aimed to assess the impact of antenatal corticosteroid timing on survival without moderate or severe neurologic disabilities at 5½ years. This was a secondary analysis of the EPIPAGE-2 study, a national population-based cohort (France) that recruited neonates in 2011 and followed them up at 5½ years (results first reported in 2021). Participants were children born alive between 24+0 and 34+6 weeks, with a complete corticosteroid course, delivery >48 hours after the first injection, and neither limitation of care decided before birth nor severe congenital malformation. The study included 2613 children, 2427 of whom were alive at 5½ years; 71.9% (1739/2427) had a neurologic assessment at this age; 1537 had a clinical examination (complete for 1532), and 202 were assessed with a postal questionnaire. Exposure was defined as the interval between the first injection of the last antenatal corticosteroid course and delivery in days, studied in 2 categories (days 3-7 and after day 7), in 4 categories (days 3-7, 8-14, 15-21, and after day 21), and continuously in days. The main outcome was survival at 5½ years without moderate/severe neurologic disabilities, defined as moderate/severe cerebral palsy, or unilateral or bilateral blindness or deafness, or Full-Scale Intelligence Quotient 2 standard deviations below the mean. A multivariate analysis with a generalized estimated equation logistic regression model assessed the statistical association between the main outcomes and the interval from the first corticosteroid injection of the last course to birth. Multivariate analyses were adjusted for potential confounders, defined with a directed acyclic graph: gestational age in days, number of corticosteroid courses, multiple pregnancy, and cause of prematurity in 5 categories. Because neurologic follow-up was complete in only 63.2% of cases (1532/2427), the analyses used imputed data. Among 2613 children, 186 died between birth and 5½ years. Overall survival was 96.6% (95% confidence interval, 95.9-97.0), and survival without moderate or severe neurologic disabilities was 86.0% (95% confidence interval, 84.7-87.0). Survival without moderate or severe neurologic disabilities was lower after day 7 (85.0%) than during the interval from day 3 to day 7 (87.0%) (adjusted odds ratio, 0.70; 95% confidence interval, 0.54-0.89). The association of a >7-day interval between antenatal corticosteroid administration and birth with a lower rate of survival without moderate or severe neurologic disabilities among children aged 5½ years emphasizes the importance of better targeting women at risk of preterm delivery to optimize the timing and thus benefits of treatment.

Efficacy and safety of oral corticosteroids to treat outpatients with acute exacerbations of COPD in primary care: a multicentre pragmatic randomised controlled study.

To compare prednisone and placebo for the treatment of outpatients treated for acute exacerbations of chronic obstructive pulmonary disease (COPD) in a primary care setting. A multicentre, parallel, double-blind, pragmatic randomised controlled trial was performed in France. A total of 66 general practitioners included patients aged ≥40 years with cumulative smoking of ≥10 pack-years and a diagnosis of certain or likely acute exacerbation of COPD. Oral prednisone (40 mg) or placebo were administered daily for 5 days. The main outcome was treatment failure at 8 weeks, defined as a composite criterion based on the occurrence of at least one of the following: unplanned visit to an emergency department or to a practitioner in the ambulatory setting, hospital admission or death. The planned sample size was 202 patients per group. 175 patients were included from February 2015 to May 2017 (43% of the planned sample). All-cause 8-week treatment failure rate was 42.0% in the prednisone group and 34.5% in the placebo group (relative risk 1.22, 95% CI 0.87-1.69, p=0.25). Respiratory-related 8-week treatment failure rate was 27.6% in the prednisone group and 13.6% in the placebo group (relative risk 2.00, 95% CI 1.15-3.57, p=0.015). Although the planned sample size was not achieved, the study does not suggest that oral corticosteroids are more effective than placebo for the treatment of an acute exacerbation of COPD in a primary care setting.

Effect of 6-week treatment with topical betamethasone dipropionate in patients with symptomatic hand osteoarthritis: A randomized double-blind, placebo-controlled trial

ObjectiveTo examine the efficacy and safety of topical corticosteroid over 6 weeks in patients with symptomatic hand osteoarthritis. DesignIn a randomized, double-blind, placebo-controlled trial, community-based participants with hand osteoarthritis were randomly assigned (1:1) to topical Diprosone OV (betamethasone dipropionate 0.5 ​mg/g in optimised vehicle, n=54) or placebo (plain paraffin, n=52) ointment to painful joints 3 times daily for 6 weeks. Primary outcome was pain reduction [assessed by 100 ​mm visual analogue scale (VAS)] at 6 weeks. Secondary outcomes included changes in pain and function using the Australian Canadian Osteoarthritis Hand Index (AUSCAN), Functional Index for Hand Osteoarthritis (FIHOA), and Michigan Hand Outcomes Questionnaire (MHQ) at 6 weeks. Adverse events were recorded. ResultsOf 106 participants (mean age 64.2 years, 85.9% female), 103 (97.2%) completed the study. Change in VAS at 6 weeks was similar in the Diprosone OV and placebo groups (−19.9 vs. −20.9, adjusted difference 0.6, 95% CI -8.9 to 10.2). There were no significant between-group differences in change in AUSCAN pain [adjusted difference 25.8 (−16.0 to 67.5)], AUSCAN function [21.2 (−55.0 to 97.4)], FIHOA [-0.1 (−1.7 to 1.5)], or MHQ [-1.2 (−6.0 to 3.6)]. Incidence of adverse events was 16.7% in Diprosone OV and 19.2% in placebo group. ConclusionsTopical Diprosone OV ointment, although well-tolerated, was no better than placebo in improving pain or function over 6 weeks in patient with symptomatic hand osteoarthritis. Future studies should consider examining joints with synovitis and whether delivery approaches enhancing transdermal penetration of corticosteroids into joints are effective in hand osteoarthritis. Trial registrationACTRN 12620000599976. Registered May 22, 2020.

Contact allergy to corticosteroids: Is the European baseline series sufficient?

Patients are consecutively screened for contact allergy to corticosteroids with budesonide and tixocortol-21-pivalate in the European baseline series. Centres using TRUE Test also include hydrocortisone-17-butyrate. A supplementary corticosteroid patch test series is used in case of suspicion of corticosteroid contact allergy or when a marker of corticosteroid contact allergy is positive. The aims were to evaluate (1) the efficacy of corticosteroids in the TRUE Test and (2) co-sensitization patterns. This retrospective study analysed patients patch tested with TRUE Test corticosteroids plus supplementary corticosteroid series in the period 2006-2020 at the Department of Dermatology and Allergy Centre, Odense University Hospital. Of 1852 patients tested, 119 were sensitised to TRUE Test corticosteroids and supplementary testing found additional reactions to other corticosteroids in 19 of 119 patients. TRUE Test corticosteroids gave more positive and stronger reactions compared to allergens in petrolatum/ethanol. Fourteen percent of sensitised patients were co-sensitised to multiple corticosteroid groups. Baeck group 3 corticosteroids accounted for 9 of 16 patients not identified by TRUE Test. Budesonide, hydrocortisone-17-butyrate, and tixocortol-21-pivalate in combination are sensitive corticosteroid markers. In case of clinical suspicion of corticosteroid contact allergy, patch testing with supplementary corticosteroids is highly recommended.