Side Effects Of Steroid Use Research Articles

POS-304 A TARGETED LITERATURE REVIEW OF PREVALENCE AND TREATMENT PATTERNS OF IgA NEPHROPATHY IN MAINLAND CHINA, TAIWAN, AND SOUTH KOREA

IgA nephropathy (IgAN) is the most common primary glomerulonephritis (GN) worldwide with higher rates in East and Pacific Asia compared to North America and Europe. Despite high reported prevalence of IgAN in these countries, the overall disease prevalence across Asia is not available. Treatment patterns of IgAN patients across Asian countries have also not been summarized. This literature review synthesized IgAN prevalence and treatment patterns among patients in Asian countries/regions, specifically Mainland China, Taiwan, and South Korea. A targeted literature review (TLR) was conducted in PubMed, Chinese (China National Knowledge Infrastructure, WANFANG) and Korean (Korean Medical Database, Korean Information Service System) databases for studies on IgAN prevalence and treatment patterns (e.g., percentage of patients using a given therapy, treatment adherence) from January 2010-May 2021. Grey literature searches using Google Scholar and Baidu (for China) were also conducted. This targeted review included 27 publications. IgAN prevalence is highly variable across Mainland China, Taiwan, and South Korea, with prevalence rates ranging from 6%-62%. In Mainland China, mean prevalence of IgAN is estimated at 25% among patients with renal biopsies (range: 6%-41%) and 38% (range: 30%-50%) among primary GN patients. In Taiwan, mean prevalence of IgAN is estimated at 12% (range: 11%-13%) among patients with renal biopsies and 26% among primary GN patients. In South Korea, mean prevalence of IgAN is estimated at 38% (range: 26%-62%) among patients with renal biopsies and 51.6% (range: 51.3%-51.9%) among primary GN patients. Country-specific treatment guidelines were identified for Mainland China only. Studies on real-world treatment patterns of IgAN were scarce in the study countries/regions. In Mainland China, only two pediatric and four adult IgAN patient studies were identified. No study reporting IgAN treatment patterns in Taiwan was identified. Three studies among adult IgAN patients in South Korea were identified. Among adult IgAN patients, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs) were the most common treatment ranging from 27.7%-90% in Mainland China and South Korea, followed by immunosuppressants (1.6%-85.5%) and steroids (10%-36.1%). ACEI/ARB and steroid use was also high among Chinese pediatric IgAN patients, ranging from 1.6%-45% across included studies. Approximately 6% of Chinese pediatric IgAN patients reported mycophenolate mofetil (MMF) use and 50% of patients underwent a tonsillectomy in one study sample. One study reported less optimal adherence with steroid treatment among Chinese IgAN patients, particularly among younger and female patients, due to concerns over side effects of steroid use. This TLR suggests variable IgAN prevalence in Mainland China, Taiwan, and South Korea. IgAN treatment primarily consisted of ACEI/ARBs, and high steroid use was found despite mixed evidence on its benefits and safety. There are also limited data on IgAN treatment patterns from Taiwan. Further research into IgAN epidemiology and treatment patterns at national levels across multiple Asian countries/regions is warranted to address gaps in evidence.

POSA20 Project Hercules - Burden of Steroid Use in the Treatment of Duchenne Muscular Dystrophy: Findings from a Targeted Literature Review and Online Survey

To explore impact of long-term high dose steroid use side effects with perceived high burden on Duchenne Muscular Dystrophy (DMD) patient and parent health-related quality of life (HRQoL) impact, personal carer burden, and health service resource use. This study is being conducted as part of Project HERCULES. A targeted literature review (TLR) was performed to identify side effects of steroid use in DMD, focussing on quantifying the HRQoL and resource use impacts. An online survey was also circulated via patient organizations in the UK to ascertain steroid side-effects of concern to parents and young people with DMD (University of Glasgow). The next phase of the research consists of the use of a Focus Group of patient-parent pairings, with a pre-Focus Group questionnaire, to qualitatively determine key themes in steroid side effect burden. The TLR identified 211 studies related to steroid side effects and burden in DMD. The majority covered steroid treatment response (154 records) or side effects (149 records). Only 11 studies covered quality of life impact, and 4 studies covered resource use and costs associated with steroid side effects, hence there is limited published evidence on burden. The online survey identified fractures (vertebral and long bone), obesity, and delayed puberty as side effects of greatest concern to parents, whereas short stature, obesity, and cushingoid features were of greatest concern to patients. These results will be used to guide discussions in the Focus Group. Steroid side effects that concern parents and the young person with DMD have not been previously explored in detail. The current research will ultimately enable recommendations for further research to quantify the HRQoL and resource use burden of steroid use in DMD, for Health Technology Assessment and development of care in areas that concern the patient community.

AWARENESS AMONGST YOUTH ABOUT USE AND ABUSE OF STEROIDS IN KARACHI, PAKISTAN

Aim of present study was to analyze awareness regarding the use of steroids in the youth studying health sciences. A descriptive, observational study was conducted from September to December 2017. Youth studying health sciences aged 21–25 years in Karachi were recruited for the study, among which (n=179) 50.99% were pharmacy students and (n=172) 49% were studying allied health sciences. Descriptive statistics (SPSS version 16.0) was used to analyze the results. Out of 400 questionnaires, the response rate was 87.75%. Majority students were knowledgeable about steroids and (72.64%) agreed that steroids should be sold as prescription only medicine in Pakistan (p= 0.00).Most of them n=147 (41.88%) had no idea about various modes of steroid abuse (p=0.00).Many participants (n= 109;31.05%) thought that steroids were found in toothpaste and dentifrices, cosmetics and ophthalmic preparations; n= 135 (38.46%) had no idea whether or not the steroids had interactions with opiates and cocaine, alcohol and benzodiazepines. The perception was seen in n= 118 (33.61%) persons that nutritional alternative/supplements could be used to reduce steroid abuse; n= 79 (22.50%) used steroids for grooming upon prescription by medical practitioner. Allergic reactions were thought as the mild side effects of steroid use by n= 100 (28.24%) while n= 166 (47.29%) considered kidney and liver diseases as severe side effects of steroid use (p=0.00). It was noted that comprehensive information about the steroids was required by youth since they were studying health sciences. Some modifications in the curriculum have to be made for providing more information about substances like steroids to the health sciences students as steroids have a great impact not only physically but also psychologically.

PGI15 - ECONOMIC IMPLICATIONS OF BUDESONIDE MMX® ADVANTAGE IN ULCERATIVE COLITIS TREATMENT OVER SYSTEMIC STEROIDS: BUDESONIDE MMX® DECREASES ULCERATIVE COLITIS TREATMENT COSTS

The main objective is to assess the economic implications of replacing standard oral corticosteroid treatment with budesonide MMX® for induction of remission in mild-to-moderate ulcerative colitis (UC). Steroid-associated adverse events (AEs) provoke high treatment costs and generate significant expenditures for the public payer. Budesonide MMX® was found to have favorable safety profile due to lower bioavailability than systemic steroids. According to these findings budesonide MMX allows for even 7-fold reduction in the risk of adverse events. Therefore, its potential to decrease AE related treatment cost requires further investigation. Electronic databases (Medline, Embase and The Cochrane Library) were systematically searched for clinical trials to compare budesonide MMX® versus other steroids and to assess long-term side effects of steroid use. The economic burden of steroid-related side effects including prevention and treatment costs was evaluated in an economic model. The risk of side effects was fitted proportionally to the cumulative dose of steroids. The costs of adverse events corresponded to the use of all resources being determined by Polish clinical practice as well as Polish and international guidelines for the treatment of all specific AEs. Costs of nine most frequent and cost-intensive serious steroid-related side effects like osteoporosis, glaucoma, cataract, hypertension, type 2 diabetes, myopathy, neuropathy, depression and vein thrombosis were estimated. The cumulative projected 20-year treatment cost of all selected side effects was 2 310 € vs 425 € per patient treated with standard oral corticosteroids and with budesonide MMX®, respectively. The results were robust under sensitivity testing. Treatment of steroid-related side effects constitutes significant long-term cost of medical care. Budesonide MMX® could allow for substantial cost reduction. The favorable safety profile outcomes has delivered strong evidence of budesonide MMX® being cost-effective compared with standard steroid therapy for induction of remission in mild-to-moderate UC.

Side effects of steroid use in patients with traumatic spinal cord injury

OBJECTIVE: Indicate and identify potential complications in our unit associated with the use of steroids in patients over 16 years of age with traumatic acute spinal cord injury managed with NASCIS II, III scheme compared with patients with the same characteristics who did not receive this management. METHODS: To conduct a research study with reports of cases and controls in patients over 16 years of age and with an established diagnosis of acute spinal cord injury, treated definitively in our unit, performing the comparison of evolutionary process between those treated with steroids and those who were not, based on the development of a data collection sheet with several variables.. The results were encoded, tabulated and analyzed. RESULTS: A total of 30 patients were analyzed from January to December 2012 and it was found that 16% of the patients managed with the steroid scheme required admission to the intensive care unit, 40% developed hospital-acquired pneumonia, 17% had urinary tract infection, 3% progressed to respiratory failure and 20% of this group had gastrointestinal bleeding. CONCLUSIONS: It was concluded that steroid management is not a risk-free therapy and the recommendation is to make a direct assessment of the potential benefit to its use in relation to the possible complications that can ensue before choosing this option in patients with traumatic spinal cord injury.

Lymphocytic Colitis in Children: 5-ASAs as Effective Treatment

Introduction: To emphasize 5-ASAs as effective treatment for lymphocytic colitis in the pediatric population. Methods: The anatomic pathology case database was queried for pediatric cases, from 2003 to 2013 to include the phrases “lymphocytic colitis” or “lymphocytosis”. Patients known to have other conditions associated with increased numbers of colonic lymphocytes (e.g., IBD) or in whom such a condition was diagnosed at the time of biopsy, were excluded from the study. Only patients with a typical histologic picture of lymphocytic colitis (increased intraepithelial lymphocytes, no more than focal neutrophilic inflammation, no significant architectural distortion) were included. Eighteen cases were initially identified. Biopsies were reviewed and the diagnosis confirmed by a pathologist (WT). Four cases were discarded as they did not meet the typical histologic criteria of lymphocytic colitis (≥20 lymphocytes/100 epithelial cells). Presenting symptoms, family history, and personal history of autoimmune disease, allergies, biopsy results, laboratory testing, initial treatment, and treatment response were all abstracted and noted. Results: Of the 14 patients included in the study (3 male, 11 female), the presenting symptoms were bloody stool in 4 patients (28.6%), diarrhea in 10 patients (71.4%), constipation in 2 patients (14.3%), abdominal pain in 9 patients (78.6%), and vomiting in 2 patients (14.3%).Two patients (14.3%) had a diagnosis of celiac disease and food allergies were noted in 2 patients (14.3%). Sulfasalazine and mesalamine preparations were used for treatment of lymphocytic colitis in 13 of these pediatric patients. One patient was not treated. Three patients (23%) displayed improvement both clinically and histologically, and 7 patients (53.8%) improved clinically without follow-up colonoscopy. One patient was lost to follow up, and 2 patients had no clinical or histological improvement. One of these improved clinically and histologically with the addition of budesonide. Overall, of the 12 patients with follow-up, there was an improvement clinically and/or histologically in 10 of these patients (83%) who were treated with 5-ASA monotherapy. Conclusion: In this retrospective study of pediatric patients, the use of 5-ASAs was successful in the treatment of lymphocytic colitis, contrary to the adult literature. Though steroids have been used successfully, this study shows the effectiveness of 5-ASAs without the negative side effects of steroid use in children.

Long-Term Outcome of Steroid-Free vs Steroid-Based Maintenance Immunosuppression in Simultaneous Pancreas/Kidney Transplants (SPK).

Purpose: Over the last decade, steroid-free immunosuppressive maintenance protocols were used in about 30% of all primary SPKs to avoid the negative long-term side effects of steroid use. While the reported short-term results are excellent, no information is available for long-term steroid avoidance in SPKs. Method: The information of the International Pancreas Transplant Registry was used to match SPKs transplants performed between 2003-2012. Only primary, DD, ED SPK transplants were entered into the study. All patients received depleting antibodies with steroids for induction therapy and maintenance therapy consisting of mycophenolate mofetil in combination with tacrolimus. The transplants were matched for the most influential recipient (age, PRA, diabetes type, race), donor (age) and transplant factors (preservation time). In addition, the transplants were also matched according to the size of their transplant center. Patient survival and graft function were described using the Kaplan-Meier method and a multivariate analysis was performed. Result: We identified 817 transplants per group which were perfectly matched. Five year patient survival was 91% in the steroid-based (+Steroid) 92% in the steroid-free -Steroid group (p=0.48). Figure 1 shows SPK pancreas and kidney graft function.Figure: No Caption available.In both pancreas and kidney graft function no statistical significant differences between the 2 treatments could be found. Of interest is the slightly better early kidney graft function with steroids and the better long-term pancreas graft function without steroids. After 42 month the steroid-free group had significantly better pancreas graft function (p=0.01). Late differences in the kidney graft function did not reach significance. In the steroid-free group, the highest risk factors were increased PRA levels and recipient age. Conclusion: are safe in SPKs and did not show any negative impact on pancreas graft function. In contrast, steroid-free protocols resulted in early kidney graft function but the difference did not reach significance.

Perioperative Steroids for Peritumoral Intracranial Edema

There has been a renewed interest in the recent literature regarding the proposed benefits of systemic steroids in the perioperative period. Among these benefits are the relief of postoperative pain, the decrease in postoperative nausea, and a higher overall multiparameter quality of recovery. Perioperative steroids, however, are not without their potential drawbacks, including decreased immune function, hyperglycemia, and impaired wound healing. The use of perioperative steroids for brain tumor treatment and resection has been a component of therapy for approximately 50 years, owing primarily to their well-described, although poorly understood, effect in minimizing vasogenic peritumoral edema, and therefore intracranial pressure. This review seeks to highlight the history, mechanisms, therapeutic efficacy, and side effects of steroid use for brain tumors in the perioperative period.

Tacrolimus combined with two different corticosteroid‐free regimens compared with a standard triple regimen in renal transplantation: one year observational results

Side effects of steroid use have led to efforts to minimize their use in transplantation. Two corticosteroid-free regimens were compared with a triple immunosuppressive therapy. Data from the original intent-to-treat (ITT) population (153 tacrolimus/basiliximab [Tac/Bas], 151 tacrolimus/MMF [Tac/MMF], and 147 tacrolimus/MMF/steroids [control]) were analyzed in a 12-month follow-up. Percentage of graft survival were 92.8%, 95.4%, and 95.9% (KM estimates 89.9%, 95.3%, 95.9%), percentage of surviving patients were 98.7%, 98.0%, and 100% (KM estimates 95.9%, 92.8%, and 100%). During months 7-12, graft loss occurred in 3 Tac/Bas, 2 Tac/MMF, and zero control patients, patient deaths in 1 Tac/Bas, 2 Tac/MMF, and zero control, and biopsy-proven acute rejection episodes in 4 Tac/Bas, 3 Tac/MMF, and zero control. Mean serum creatinine at month 12 was 141.9 +/- 69.6 microM, 144.0 +/- 82.1 microM, and 134.5 +/- 71.2 microM (ns). New-onset insulin use in previously non-diabetic patients at month 12 was 1/138, 6/127, and 4/126. Patient and graft survival as well as renal function at 12 months were not different between patient groups, despite considerably higher rates of acute rejection occurring within the first six months after transplantation in both steroid-free patient groups. Tac/Bas therapy might offer benefits in terms of a trend for a more favorable cardiovascular risk profile.

Recognising the side-effects of steroid use

A pictorial presentation to download showing the side-effects of steroid use including skin atrophy, tinea incognito, acne rosacea, telangiectasia and purpura, angina bullosa haemorrhagica and osteoporosis.

Defining the impact and contribution of steroids in patients receiving whole-brain irradiation for cerebral metastases.

To assess the impact of steroid therapy in the management of brain metastases by review of the published literature on whole-brain radiotherapy (WBRT) for multiple cerebral metastases. Twenty-one full manuscripts of published randomised controlled trials (RCTs) involving WBRT for multiple cerebral metastases were identified from a literature search and included studies from 1971--2003. Details on the use and type of steroid, timing of steroids relative to radiotherapy, response assessment and contribution of steroids to overall outcome were extracted. Eighteen out of 21 trials commented on steroid use. All studies used overall survival as an assessment of outcome; 13 studies assessed neurological response and 10 used imaging assessment. Ten studies acknowledged a contribution from steroids in the response assessment or analysis, but only one study gave a fixed steroid dose to control for its palliative effect. Reporting of steroid use in published RCTs assessing treatment for patients with brain metastases is non-uniform and not sufficiently detailed. As such, it is difficult to assess the additional benefit of WBRT. A standardised approach to the incorporation of steroid effect in assessment of WBRT would be advantageous to determine symptom response or durability of response. Side-effects of steroid use and the ability to taper off steroids after treatment intervention are also important outcomes of interest.

Little Help from Article on Anaboiic Steroids

To the Editor.— As a high school teacher I have been looking for guidance on preventing the abuse of anabolic steroids by our students. The article "Anabolic Steroid Use by Male Adolescents" by Johnson et al1 not only failed to provide this guidance, but the results failed to support the authors' conclusions. The study shows that, of the teenage users of steroids surveyed, 38% correctly identified liver disease, 35% cancer of the liver, and 30% stunted growth as side effects of steroid use.