Oral Prednisolone Dosage Research Articles

Moon-like Facies by Glucocorticoid Is Associated With the Development of Diabetes and Body Image Disturbance.

Moon-like facies (MLF) are a typical side effect of glucocorticoid (GC) therapy; however, its predisposing factors, relationship with GC-induced complications, and effects on body image are not well understood. This study aimed to determine the predisposing factors for MLF during GC therapy; its association with GC-induced diabetes, hypertension, and dyslipidemia; and its effects on body image. This prospective observational study spanned 24 weeks and targeted patients who received GC therapy at the University of Yamanashi Hospital from June 2020 to August 2022. The MLF was defined based on the following 3 factors: (1) an increase in facial measurement lengths, (2) subjective facial changes by patients' self-assessment using a visual analog scale; (3) objective and qualitative facial changes assessed by physicians. We examined the predisposing factors for MLF and the association of MLF with GC-induced diabetes, hypertension, dyslipidemia, and body image. The cumulative incidence rate of MLF at 24 weeks was 37.6%. Predisposing factors for MLF were an initial oral prednisolone dosage of ≥ 30 mg/day [odds ratio (OR) 63.91, 95% confidence interval (CI) 5.82-701.81] and female (OR 6.66, 95% CI 1.35-32.79). MLF showed a significant association with the onset of GC-induced diabetes (OR 6.58, 95% CI 1.25-34.74). MLF was also an independent factor contributing to body image disturbance (β = -18.94, P = .01). MLF contributes to body image disturbance and is associated with the development of GC-induced diabetes; therefore, it is clinically important as a physical manifestation of GC therapy.

Demographics and treatment of patients with primary membranoproliferative glomerulonephritis in Japan using a national registry of clinical personal records

BackgroundMembranoproliferative glomerulonephritis (MPGN) is a rare glomerular injury that causes nephrotic syndrome and end-stage kidney disease. The nationwide demographics and treatment of Japanese patients with primary MPGN have not yet been reported.MethodsWe collected clinical personal records of patients with primary MPGN between 2015 and 2018 from the national registry organized by the Japanese Ministry of Health, Labour, and Welfare and investigated the characteristics of primary MPGN throughout Japan.ResultsOf 258 patients with primary MPGN, 199 and 59 showed nephrotic and non-nephrotic syndrome, respectively. The median age at onset was higher in patients with nephrotic syndrome than in those with non-nephrotic syndrome (45 [24–63] vs. 35 [14–53] years, respectively; P = 0.010). The use of oral prednisolone was significantly higher in patients with nephrotic syndrome than in those with non-nephrotic syndrome (73.9% vs. 59.3%, respectively; P = 0.032). When patients were divided into three age groups: adolescent and young adult group (≤ 39 years; n = 80), middle adult group (40–64 years; n = 111), and older adult group (≥ 65 years; n = 67), the use of oral prednisolone, cyclosporine, and mizoribine was significantly higher in the adolescent and young adult group than in the middle adult group. The mean dosage of oral prednisolone and mizoribine showed no differences among the three age groups.ConclusionThe national registry of clinical personal records of primary MPGN could provide an informative insight into the characteristics, clinical features, and treatment approaches for patients with primary MPGN in Japan.

Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran.

Background Treating oral mucosal lesions of Pemphigus Vulgaris (PV) disease is usually challenging for clinicians. We studied the treatment outcomes of the oral PV patients referred to the Oral Medicine Department of Shiraz University of Medical Sciences from 2004 to 2018. Methods The medical records of 54 oral PV patients with histopathological confirmation who were treated by a single protocol were studied. The protocol consisted of initial treatment with 1 mg/kg/day of oral prednisolone for all patients. After 4–6 weeks, all patients were prescribed 40 mg of prednisolone. If lesion recovery was not observed or new lesions had developed, adjuvant therapy (maximum dose of 200 mg per day of Azathioprine (AZA)) was initiated anytime during the treatment. The oral prednisolone dosage was gradually tapered to 5 mg/alternate day in 9 months. Results 47 patients were included in the study. 34.04% were male and 65.96% were female with a mean age of 41.83 ± 12.520. The mean follow-up period was 50.806 ± 44.417 months (over 4 years). The severity of oral involvement was mild in 21.27%, moderate in 36.17%, and severe in 42.6%. During treatment, all patients except one experienced complete remission. The mean time to achieve complete remission was 150.39 ± 224.075 days. Most of the patients experienced relapse due to self-discontinuation of treatment. 55% had complete remission and 43% were in partial remission at the last follow-up session. In 65.96% of patients, treatment-associated side effects were observed. The patients treated with prednisolone alone had significantly more side effects than those using AZA as an adjuvant (80% vs 50%, respectively; P=0.030). The mean duration of follow-ups was longer for patients with side effects (P < 0.01). Topical corticosteroids were used for all patients sometime during the treatment. No deaths were recorded. Conclusion Prescribing low-dose prednisolone and adding AZA in nonresponding cases has good clinical outcomes for the treatment of oral lesions of PV. Adjuvant therapy can avoid the increase in corticosteroid dosage and side effects. The treatment method described in this study can be a helpful guide for clinicians, especially when other immunosuppressive drugs are not available.

Oral steroid decreases the progression of joint destruction of large joints in the lower extremities in rheumatoid arthritis.

To identify the risk factors for destruction of large joints in the lower extremities in patients with rheumatoid arthritis (RA) during a 4-year follow-up period in a prospective study.We enrolled consecutive patients who participated in both 2012 and 2016. Clinical data, disease activity, and types of medication were collected in 2012. Standard anteroposterior radiographs of weight-bearing joints (hips, knees, and ankles) were taken in 2012 and 2016. Radiographic progression was defined as progression in the Larsen grade or the need for joint arthroplasty or arthrodesis. The association between baseline characteristics and the incidence of radiographic progression was statistically assessed.A total of 213 patient were enrolled, and, after exclusion, 186 patients were analyzed. Sixty 9 patients (37.1%) showed radiographic progression in 1 of the large joints in the lower extremities. Multivariate regression analysis showed that radiographic progression was associated with older age, higher disease activity, and the presence of radiographic destruction at the baseline. The lower dosage of oral prednisolone was a significant risk factor compared with higher dosage when used.Patients with the risk factors should be followed closely to limit the progression of large joint destruction in the lower extremities.

Factors associated with discontinuation of glucocorticoids after starting biological disease-modifying antirheumatic drugs in rheumatoid arthritis patients

Objectives: Glucocorticoids (GCs) are effective treatments for rheumatoid arthritis (RA) but long-term use has adverse effects. This study aimed to elucidate whether GCs can be discontinued by introducing biological disease-modifying antirheumatic drugs (bDMARDs) and the factors influencing the outcome.Method: We included RA patients who had been orally taking GCs at the initiation of bDMARDs. The changes in GC dose after starting bDMARDs were evaluated and the GC discontinuation rate was analyzed using Kaplan–Meier analysis. The factors associated with discontinuation of GCs were assessed by Cox hazard models.Results: Eighty RA patients were included in the study. The dosage of oral prednisolone (PSL) was significantly reduced from 5.0 to 3.0 mg/day by 3 months (p = .013). GCs were discontinued in 31.3% of patients and the median time until GC discontinuation was 10.1 months. The GC discontinuation rate was significantly higher in patients with Class 1 and 2 (p = .024), with an initial PSL dose <5 mg/day (p = .040), and with low DAS28(ESR) (p = .038). In multivariate analyses, higher DAS28(ESR) (odds ratio, 0.200; p = .039), and higher PSL dose (odds ratio, 0.748; p = .029) were significantly associated with less frequent GC discontinuation.Conclusion: DAS28(ESR) high and PSL dose were factors associated with discontinuation of GC use after starting bDMARDs.

Mizoribine as a safe and effective combined maintenance therapy with prednisolone for anti-neutrophil cytoplasmic antibody-associated vasculitis in a hemodialysis patient.

A 77-year-old man developed severe renal insufficiency due to proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, and was started on hemodialysis (HD). Because his renal insufficiency appeared to be irreversible, he was maintained on oral prednisolone (PSL) at 5 mg/day. However, a disease flare-up with alveolar hemorrhage occurred. Serology revealed elevated levels of PR3-ANCA and C-reactive protein (CRP). The patient was given pulse therapy with a quarter dose of methylprednisolone (m-PSL) (250 mg, 3 days), followed by oral PSL at 15 mg/day. As a supplemental treatment, he was given 25 mg of mizoribine (MZR) immediately after each HD session. Subsequently, the levels of PR3-ANCA and CRP decreased, and the alveolar hemorrhage resolved. The dose of MZR to be given was determined by measuring the patient’s serum concentrations of MZR at various time points after the HD session. The maintenance dose of MZR was finally set at 50 mg. At present, the oral PSL dosage has been tapered to 10 mg/day, and the patient has achieved a state of remission without any side effects.

P258 Role of 7-day and 14-day courses of oral prednisolone treatment in acute exacerbation of COPD

PurposeThe purpose of this study was to compare the efficacy of 7-day and 14-day courses of oral prednisolone treatment in patients with acute exacerbation of COPD with FEV1<50% predicted.MethodsIt was...

Improvement of rapidly progressive lupus nephritis associated MPO-ANCA with tacrolimus

A 43-year-old Japanese woman with systemic lupus erythematosus (SLE) developed rapidly progressive renal failure and nephritic syndrome with a high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). Methylprednisolone pulse therapy did not suppress the progression of renal failure. Intravenous cyclophosphamide pulse therapy and administration of azathioprine was abandoned due to adverse effects. Tacrolimus was employed as an alternative immunosuppressive therapy and was well tolerated, effectively preventing renal failure. Oral prednisolone dosage was successfully tapered without recurrence, along with decreasing titer of MPO-ANCA. Renal biopsy showed diffuse proliferative lupus nephritis (International Society of Nephrology/Renal Pathology Society class IV-G A/C) with crescent formation. These findings indicate that in addition to lupus nephritis, which usually results from deposition of circulating or locally formed immune complexes, MPO-ANCA may be involved in the pathogenesis of crescentic glomerulonephritis. Furthermore, we propose that tacrolimus is an effective immunosuppressant for MPO-ANCA-related renal crisis in diffuse proliferative lupus nephritis.

Management of rejection following heart transplantation using oral steroid medication

After 47 orthotopic heart transplantations with long-term immunosuppression (cyclosporin A, 3-10 mg/kg; azathioprine, 1-2 mg/kg; prednisolone 0.1 mg/kg) there were 306 episodes of acute rejection. In 44 of these (14.8%) the oral prednisolone dosage was increased, from a mean of 10.8 +/- 2.95 mg/d to 36.6 +/- 7.2 mg/d, followed by stepwise reduction to the original maintenance dose. Compared with the customary intravenous bolus administration (1.0 g/d for three days: success rate 89%), the oral schedule was successful in 33 of the 44 episodes of rejection (75%). It is concluded that in selected patients acute rejection episodes after heart transplantation can be successful treated by an increase in the oral dose of steroids without changing the dosage of the other two immunosuppressive drugs.

Aortic regurgitation associated with rheumatoid arthritis: A case report

We herein report a rare case of aortic regurgitation (AR) associated with rheumatoid arthritis (RA). A 71-year-old female patient with a history of hypertension for 6 years had started steroid medication for the treatment of RA. The dosage of oral prednisolone had been gradually reduced over the following year. The patient presented with paroxysmal nocturnal dyspnea 2 days after the discontinuation of prednisolone. On arrival, the pulse pressure was 140 mm Hg, with a blood pressure of 190/50 mm Hg.

Rectal bismuth subsalicylate as therapy for ulcerative colitis

In a prospective open study, 15 patients with ulcerative colitis which was unresponsive to conventional therapy were treated with enemas containing bismuth subsalicylate (700 or 800 mg b.d.). Nine out of the 15 patients showed a significant clinical response, and 6 had gone into complete clinical remission after 8 weeks treatment. Sigmoidoscopoic appearances of the rectal mucosa showed improvement in 9 out of 15 patients at 2 weeks, and 11 out of 15 at 8 weeks. The mucosa appeared sigmoidoscopically normal in 6 out of 15 at 8 weeks. It proved possible to reduce the oral prednisolone dosage from a median of 15 mg/day (range 10 to 35 mg/day) to 6 mg/day (range 0 to 18 mg/day) after 8 weeks of treatment; 5 patients were no longer taking oral steroids at this time. Rectal bismuth subsalicylate appears likely to be an effective therapy in ulcerative colitis and controlled trials are now required.

Tacrolimus as a reinforcement therapy for a patient with MPO-ANCA-associated diffuse alveolar hemorrhage

A 67-year-old woman, suffering from continuous hemoptysis, was admitted to our hospital where she was managed with mechanical ventilation. Computed tomography of the chest demonstrated bilateral massive alveolar hemorrhage without evidence of infectious disease. She was diagnosed with anti-myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated diffuse alveolar hemorrhage because a high titer of MPO-ANCA was found in the serum. Plasmapheresis as well as methylprednisolone pulse therapy were initiated, followed by intravenous administration of cyclophosphamide. Tacrolimus was employed for the maintenance therapy, and the oral prednisolone dosage could successfully be tapered without recurrence, along with the decrement of the titer of MPO-ANCA.

Infliximab is Effective for Takayasu Arteritis Refractory to Glucocorticoid and Methotrexate

We have experienced a Takayasu arteritis (TA) patient, successfully treated with infliximab, who did not respond well to conventional therapy with glucocosteroid and methotrexate. Takayasu arteritis had developed in a 24-year-old woman (March 2003) who had been treated with glucocorticoid including methylprednisolone pulse therapy and methotrexate; however, she relapsed during the tapering of the dosage of oral prednisolone. Nineteen months after the first administration of glucocorticoid, 3 mg/kg of infliximab was introduced to the patient. The therapeutic efficacy of infliximab was markedly demonstrated; the patient's C-reactive protein (CRP) value returned to almost normal range with subsequent tapering of the dosage of oral prednisolone in the absence of further relapse. This is the first case presentation of TA in Japan successfully treated with infliximab.

Levamisole in steroid-sensitive nephrotic syndrome children with steroid-dependency and/or frequent relapses.

The study is to evaluate the effect of levamisole on steroid-sensitive nephrotic syndrome (SSNS) children with multiple relapses, from October 1996 through December 1998, we prospectively recruited 27 SSNS children. Eight children had minimal change nephrotic syndrome and nine had mesangial nephropathy proven by renal biopsy. The other 10 children had normal renal function and no secondary cause of nephrotic syndrome (NS). Nine were frequent relapsers (FR), (> 4 attack per year), nine were steroid-dependent (SD), and another nine were both FR and SD. The dosage of levamisole given was 2 to 3 mg/kg daily or every other day, depending on the patients' response. All were followed regularly at outpatient department. Follow-up items included a routine urinalysis every month, complete blood count (CBC) every 3 months and BUN/Cr, AST/ALT every 6 months. After 6 to 24 (mean 12.2) months of follow-up, the frequency of relapse (FoR) decreased (5.74 +/- 3.24 vs 1.91 +/- 2.0/year p < 0.05). Seven (26%) had no relapse at all. Nine (33.3%) had less than 1/3 the FoR; four (14.8%) had 1/3 to 1/2 the FoR; and seven (26%) still had more than 1/2 FoR as before levamisole. The oral prednisolone dosage also decreased (0.62 +/- 0.42 vs 0.21 +/- 0.35 mg/kg/day, p < 0.05). The levamisole response was independent of the age of NS onset, the interval between NS onset and initiation of levamisole, previous number of relapse, the FoR, and previous use of cytotoxic drug. There were 7 episodes of leukopenia, which returned to normal after discontinuing levamisole for 1 to 2 weeks in 4 patients. Two (7.5%) had reversible leukopenia for more than 4 weeks. No abnormal BUN/Cr, or ALT/AST levels were noted during follow-up. Levamisole is an effective and safe drug for children who have SSNS with FR and/or SD. Two thirds of patients obtain satisfactory control. The dosage can be 2 to 3 mg/kg daily or every other day. The most common side effect is transient leukopenia.

Management of acute asthma attacks associated with respiratory tract infection: a postal survey of general practitioners in the U.K.

Asthma attacks in general practice are frequently associated with respiratory tract infection. The aim of this study was to examine how U.K. general practitioners (GPs) might use oral steroids and antibiotics in such situations. The timing of follow-up and use of self-management plans were also examined. A postal questionnaire was sent to all 205 GP principals in Bath Health District, U.K. in February and March 1993. Respondents were asked questions regarding the management of an adult and a child presenting with acute asthma associated with respiratory tract infection. Replies were received from 185 of 205 (90%) doctors approached. Antibiotics would have been prescribed by 119 of 179 (66%) doctors for the adult and 98 of 169 (58%) doctors for the child. The modal initial dosage of oral prednisolone was 40 mg for the adult and 30 mg for the child, and modal duration of oral steroid dosage was 5 days for both adult and child. Planned follow-up was mainly doctor initiated within 24 h of initial consultation. There was low reported use of self-management plans (49% for adults and 33% in children over 7 years of age). Antibiotic prescription appears to be common practice by GPs when faced with an acute asthma attack associated with respiratory tract infection. There may also be inadequate duration of oral steroid courses in adults. There is a need to examine further the proper role, if any, of antibiotics in such situations, to determine the optimum dose and course length of oral steroid therapy, and to continue validating the use of self-management plans in acute asthma management.