Combined Steroid Therapy Research Articles

Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.

To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential analysis (TSA). The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that included adult patients with IHCA, with at least one group receiving combined VSE therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other outcomes included survival to hospital discharge or survival to 30 and 90 days, with good neurological outcomes. We included a total of three RCTs (n = 869). Results showed that VSE combination therapy increased ROSC (risk ratio = 1.41; 95% CI: 1.25-1.59) as compared to placebo. TSA demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], P < 0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies. VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC. Future trials of VSE therapy should evaluate survival to hospital discharge, neurological function and long-term survival.

Combination Therapy and Single-Modality Treatment for Acute Low-Tone Hearing Loss: A Meta-Analysis with Trial Sequential Analysis.

Acute low-tone hearing loss (ALHL) is a common clinical disease and was first proposed by Abe in 1981 as sensorineural hearing loss confined to low frequencies. The best strategy for initiating medication is still unclear, as the superiority of steroids and diuretics is still debated, and combination therapy might yield additional benefits. However, no study regarding combination therapy has been published. The objective of this study was to evaluate the efficacy of steroid therapy versus combination therapy of diuretics with steroids by conducting a systematic review with a meta-analysis and trial sequential analysis (TSA). Studies enrolling patients with a diagnosis of acute low-tone hearing loss were considered eligible. After searching the PubMed, Cochrane Library, Embase, Scopus and Web of Science databases from inception to 31 December 2021, five studies including 433 patients were enrolled. Overall, the comparison between combination therapy with steroids and diuretics and single-modality treatment with steroids (OR, 1.15; 95% CI, 0.51 to 2.59; p = 0.74; I2 = 34%) and the comparison between combination therapy and treatment with diuretics alone (OR, 1.73; 95% CI, 0.93 to 3.23; p = 0.09; I2 = 5%) showed that combination therapy did not confer significant benefits when compared to single-modality treatments. A trial sequential analysis (TSA) showed conclusive nonsignificant results of the comparison between the combination of steroids and diuretics and a single-modality treatment. In conclusion, we reported that the combination of steroids and diuretics did not yield significant benefits when compared to single-modality treatment with steroids or diuretics. We suggest that treatment should be initiated with steroids or diuretics alone to avoid potential adverse effects.

Role of Corticosteroids along with Other Therapies for Treatment of Idiopathic Granulomatous Mastitis: A Narrative Review

Background: The use of oral corticosteroids to treat idiopathic granulomatous mastitis (IGM) has been a point of controversy for a long time. In addition, a wide diversity of combinations with other therapies have been reported so far. This study aims to review the usage of oral corticosteroids and their combinations in the published literature. Methods: PubMed and Scopus were searched using the key word “granulomatous mastitis.” Citations were filtered in two stages, considering the titles/abstracts and full texts. Papers reporting the treatment of IGM with corticosteroids with/without other treatments were included. Results: Fifty-eight citations were included in this study, 31 of which had at least a group of patients treated only with systemic corticosteroids. Combination therapy of systemic steroids with immunosuppressants, surgical interventions, and antibiotics were used in 6, 12, and 13 studies, respectively. Conclusion: Considering the inconsistency of studies in reporting the severity of the disease, administered treatments, outcome of treatment, side effects, and follow-up, our study failed to provide solid evidence for using corticosteroids as the first step in the management of idiopathic granulomatous mastitis. There is still a need for further studies emphasizing the homogenization of such reports. In this regard, preparing a questionnaire to help homogenize future reports on IGM is highly recommended.

Characteristics and Treatment Methods of Bell’s Palsy in Patients Visiting Korean Medicine Hospitals From August 2018 to July 2021

Background: This study was designed to statistically analyze the data of patients who had Bell’s palsy (BP) who visited a Korean Medicine hospital in the last 3 years to determine the tendency or characteristics of their visit.Methods: This study retrospectively analyzed the medical records of 816 patients. Based on the data collected through medical records demographics, condition/disease, and therapeutic characteristics of the patients were analyzed using IBM SPSS Version 23.0.Results: Patients in their teens or younger, and 50s or older had a higher frequency of inpatient treatment, and 20s to 40s had a higher rate of outpatient treatment. The proportion of men who received steroid combination treatment was higher than women. The number of patients with BP, and the total treatment period of the patients has decreased every year. The total treatment period was shorter in the steroid group than the Korean medicine alone group. Inpatients were more likely to receive steroid combination therapy than outpatients. The proportion of patients who received steroid combination therapy was higher than patients with recurrence of BP. Patients with hypertension or diabetes had a higher rate of hospitalization and received more treatments than patients without the condition/disease.Conclusion: Visit characteristics and treatment methods preferred by patients with BP were identified. This research may help to establish a treatment model for BP in Korean Medicine institutions in the future.

Infective and nonbacterial thrombotic endocarditis in patients with post-COVID-19 viral-immune myocarditis

The possibility of heart inflammation (both myocardial and endocardial) months after a coronavirus disease 2019 (COVID-19) has not been practically studied, especially since approaches to the treatment of myocarditis in combination with various endocarditis forms have not been developed.Aim. To study the prevalence and mechanisms of SARS-CoV-2-associated endocardial injury in patients with morphologically verified post-COVID-19 myocarditis, as well as to develop approaches to comprehensive therapy.Material and methods. The study included 18 patients with severe morphologically verified post-COVID-19 myocarditis (men, 9; 51,1±9,4 years; 35 to 66 years). Patients with prior verified myocarditis/myocardial infarction, rheumatic heart disease, and systemic immune diseases were excluded. The average time after COVID-19 was 6,5 [3.5; 10] months The diagnosis of myocarditis was confirmed by endomyocardial biopsy (including immunohistochemical examination with antibodies to CD3, CD20, CD45, CD68, and to SARS-CoV-2 antigens; polymerase chain reaction for SARS-CoV-2 RNA, DNA of cardiotropic viruses). The blood level of anticardiac antibodies was determined by indirect immunofluorescence. In addition, echocardiography, magnetic resonance imaging (n=8), cardiac multislice tomography (n=1), and coronary angiography (n=14) were performed.Results. Biopsy revealed active (n=12) and borderline (n=3) lymphocytic myocarditis, eosinophilic (n=2) and giant cell (n=1) myocarditis. In 4 patients, nonbacterial thrombotic endocarditis (NBTE) with parietal and intravascular thrombosis was diagnosed, and in one patient — infective endocarditis (IE) of the bicuspid aortic valve. Myocardial persistence of SARS-CoV-2 was detected in 72% of cases (in 3 patients — with NBTE; in 1 — with IE; in 9 — without endocarditis). Titers of anticardiac antibodies increased by 3-4 times in 94% of patients. Patients with endocarditis were characterized by larger heart chambers, lower ejection fraction (27,5±6,6 vs 36,0±13,4%), more severe pulmonary hypertension, and valvular regurgitation. Intraventricular thrombosis according to echocardiography/magnetic resonance imaging and cardiac embolism was not observed. Treatment in all patients included methylprednisolone at an average dose of 24 mg a day. In 10 patients, the result was monitored for at least 3 months as follows: the ejection fraction was 46,0±12,7% and 44,3±7,3% in patients with and without endocarditis, respectively.Conclusion. Endocarditis in patients with post-COVID-19 myocarditis was detected in 28% (1 patient — IE; 4 — NBTE). The key mechanisms of post-COVID-19 myocarditis and NBTE are long-term (up to 18 months) myocardial persistence of SARS-Cov-2 and the development of an autoimmune reaction. Endocarditis was diagnosed in more severe patients, including those with giant cell and eosinophilic myocarditis. The effectiveness of steroid therapy in combination with anticoagulants in patients with NBTE requires further study. In case of IE, steroids can also be used in the treatment of myocarditis (in combination with antibiotics and immunoglobulin).

Safety of sequential biological therapy in inflammatory bowel disease: results from a tertiary referral centre.

Biologicals represent the cornerstone of treatment for moderate-to-severe inflammatory bowel diseases (IBD). Many patients cycle between biologicals when encountering loss of response or adverse events. To assess the occurrence of serious infections and malignancies with exposure to several (classes of) biologicals. We performed a retrospective cohort study in a tertiary referral centre including consecutive IBD patients exposed to adalimumab, infliximab, ustekinumab or vedolizumab between 1996 and 2019. All serious infections and malignancies, as well as potential confounders, were accounted for. In total, 1575 patients were included with a median (interquartile range) follow-up of 10 (6-16) years and a duration of biological therapy of 71 (39-112) months. Incidence rates of serious infections were 3.4 per 100 patients' years (PY) in the post-biological setting. Serious infections after biological exposure were associated with systemic steroids in monotherapy (hazard ratio 2.96 [95% confidence interval 1.78-4.93], p< 0.0001), combination therapy of systemic steroids and a biological (2.44 [1.37-4.34], p= 0.002), female gender (1.25 [1.04-1.51], p= 0.02), and prior serious infections in the pre-biological setting (1.42 [1.03-1.96], p= 0.03). Malignancy rates were 1.06 per 100PY in the post-biological setting and increased with older age at biological initiation (1.04 [1.02-1.05], p< 0.0001). The risk for serious infections or malignancies was independent of type and number of biologicals to which the patient was exposed. This study shows that the sequential use of biological therapy in IBD does not seem to convey an overall higher risk of serious infections or malignancies, but that underlying more refractory disease seems to increase this risk.

Assessment of effectiveness of Ozonated olive oil fused with corticosteroids for the management of oral erosive lichen planus

Erosive lichen planus is counted amongst the most debilitating conditions of oral cavity which has multifactorial etiology and malignant turnover potential. It has been documented that ozonated olive oil have healing, anti-inflammatory, antimicrobial and antioxidant properties and thus have great potential in management of the ulcerative lesions. Present study is aimed to evaluate and compare the efficacy of using ozonated olive oil combined with systemic steroid and antioxidant in the management of erosive lichen planus. Materials and methods: Eighty patients with a confirmed clinical and histopathologic diagnosis of erosive OLP were randomly allocated into four groups. Group I, II, III and IV were prescribed systemic Prednisolone 40 mg/day,soft-gel capsule lycopene (6 mg/day), combination therapy of systemic steroid (40mg/day) along with ozonated olive oil and combination therapy of lycopene (16 mg/day) and ozonated olive oil respectively. OLP clinical course was assessed by measuring severity of pain, burning sensation(VAS), clinical signs(scale of Thongprasom) and efficacy of the treatment(efficacy index methods of Liu set). Patients were monitored on regular follow up.

Intratympanic Versus Systemic Steroid Therapy for Idiopathic Sudden Hearing Loss: A Systematic Review and Meta-Analysis.

Idiopathic sudden sensorineural hearing loss (ISSHL) is a common condition characterized by hearing threshold reduction, most often of unknown causes. The patient experiences a sudden reduction of the hearing threshold in one or both ears. Steroids are the mainstream of the treatment. This study aims to investigate the effectiveness of intratympanic steroid administration compared with systemic administration and the combination of the two steroid treatments in the hearing recovery of patients with idiopathic sudden sensorineural hearing loss. We searched electronic databases such as PubMed, ScienceDirect, CINAHL, Cochrane (Central), Ovid, and Medline from August 31, 2021, to November 31, 2021, and from February 5 to 10, 2022. We included 12 randomized controlled trials (RCTs) and performed a meta-analysis comparing the efficiency in the hearing recovery of intratympanic versus systemic steroid treatment, systemic versus combined, and intratympanic versus combined steroid treatment. The results of the intratympanic versus systemic steroid therapy comparison showed no actual difference in efficiency and no statistical significance (odds ratio: 1.07 (Mantel-Haenszel (M-H), fixed, 95% confidence interval (CI): 0.76-1.51)). Systemic steroid treatment was inferior to combined steroid treatment and was the only outcome with statistical significance (odds ratio: 0.55 (M-H, fixed, 95% CI: 0.38-0.80)). Intratympanic steroid treatment was inferior to combined steroid treatment, although the results were not statistically significant (odds ratio: 0.65 (M-H, fixed, 95% CI: 0.37-1.16)). In conclusion, systemic steroid therapy was inferior to combined steroid therapy. The comparison of intratympanic with systemic therapy and intratympanic with combined therapy showed no statistical significance. Further research is needed with more RCTs, and side effects should be considered.

Necessity and choice of therapy for Henoch-Schönlein purpura nephritis.

Henoch-Schönlein purpura nephritis often resolves spontaneously, without treatment, making decisions regarding therapeutic interventions difficult. Fifty-four patients who were diagnosed as having Henoch-Schönlein purpura nephritis between April 2004 and March 2018, and developed hematuria and/or proteinuria, were studied retrospectively. The observation period ended at the disappearance of hematuria or proteinuria, or the last observation date before December 2019 for each patient. Twenty-four of the patients received no treatment (Group A), 19 underwent renin-angiotensin-aldosterone system inhibitors only (B), 4 experienced steroid pulse therapy and combination therapy only (C) and the remaining 7 received steroid pulse therapy and combination therapy following renin-angiotensin-aldosterone system inhibitors (C). Clinical characteristics were examined according to the treatment method. Survival analysis for persistent urinary abnormalities was performed according to treatment modality, with multiple treatment records created per subject, if necessary. The highest urine protein/creatinine levels were significantly higher in groups B and C than in group A. The lowest estimated glomerular filtration rate was not significantly different among the three groups. In groups A and B, proteinuria resolved in >90% of patients. Survival analysis showed that steroid pulse therapy and combination therapy was not related to the better resolution of hematuria or proteinuria than renin-angiotensin-aldosterone system inhibitors. Several patients with Henoch-Schönlein purpura nephritis went into remission either without treatment or with renin-angiotensin-aldosterone system inhibitors alone. The treatment plan for patients with Henoch-Schönlein purpura nephritis needs to be determined carefully.

Influenza associated acute necrotizing encephalopathy and COVID-19 encephalopathy; a comparative review

Acute necrotizing encephalopathy (ANE) is influenza-associated encephalopathy (IAE) that mostly occurs in younger age groups following an acute viral illness with a very low recovery rate. It is a rare but rapidly progressive neurodegenerative disorder which pathogenesis is still not clear. There are some cases reported where the virus can directly invade the central nervous system (CNS) through the peripheral nervous system. Several pathogenic conditions like rising levels of proinflammatory cytokines, dissolving the blood-brain barrier (BBB), etc can trigger the viral infection. There are no specific treatments available but initial steroid therapy in combination with antivirals and hypothermia therapy were found efficacious in some cases. Similarly, coronavirus disease 2019 (COVID-19) encephalopathy is caused by a novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). Having a very low recovery rate, and still unknown pathophysiology, this condition is proved to be fatal for immunocompetent adults. Treatments are not available but drugs like remdesivir, hydroxychloroquine, tocilizumab, and losartan were used to reduce the viral infection. No recurrent cases have been reported so far, but reinfection of the virus can trigger hypoxic encephalopathy. This review mainly focuses on a comparative study to understand the pathophysiology to help for discovering a new area of drug development.

Effect of Primary Care on Reducing Rates of Hospitalization Among Chronic Obstructive Pulmonary Disease Patients

The normal course of Chronic obstructive pulmonary disease (COPD) includes a progressive reduction in lung function, exacerbations that necessitate primary care intervention or hospital admission, a steady decline in quality of life, and a shorter life expectancy. COPD is one of the ambulatory or primary care-sensitive illnesses for which it is hypothesized that efficient primary care management will lower the probability of hospital admission. Long-acting beta-agonist and inhaler steroid combination therapy improves spirometric results and overall health while lowering the annual risk of COPD exacerbations. Use of two or more treatment modules based on models designed specifically for chronic care delivery in developed countries have proven successful in lowering hospitalizations as well. Access to other therapies, such as pulmonary rehabilitation, acute exacerbation evaluation programs, and community or hospital-based respiratory specialists, may also be important. The goal of interventions to lessen the prevalence of COPD in underserved areas has to focus on locally driven integrated solutions, such as media campaigns to raise awareness and persuade at-risk individuals to get tested, as well as training for primary care workers on the significance and advantages of earlier detection and effective operation of chronic obstructive pulmonary disease. Importantly, uptake of influenza vaccination has demonstrated a link with hospital admission rates at the practice level. Proposed solutions for lowering hospitalization and reducing exacerbations among patients with COPD include greater access to pulmonary rehabilitative care, more rigorous implementation of smoking cessation programs and availability of modern long-acting medications.

Combination therapy of tocilizumab and steroid for COVID-19 patients: A meta-analysis.

The coagulation markers, pro‐inflammatory cytokines (such as IL‐2R, IL‐6, IL‐10, and TNF‐a) and lymphopenia are associated with the severity of coronavirus disease 2019 (COVID‐19) disease. The use of anti‐inflammatory agents, such as corticosteroids (CS) or tosilizumab (TCZ), has been suggested for the treatment of advanced stage of COVID‐19 and the reduction of mechanical ventilators and mortality. The aim of this meta‐analysis is to determine the role of combination therapy with tocilizumab and steroids in COVID‐19 patients. Relevant studies were found using online international databases, and suitable studies were selected and assessed by two independent researchers. The quality of all papers was determined by a checklist. Heterogeneity assay among the primary studies was evaluated by Cochran's Q‐test and I2 index. The statistical analyses were done using the Stata ver. 14 package (StataCorp) software. Publication bias was estimated through Egger's test, and the impact of each study on the overall estimate was assessed by sensitivity analysis. Five studies were entered into this meta‐analysis. The results of these studies showed that the risk of death for COVID‐19 patients treated with the combination of corticosteroids and tocilizumab compared to tocilizumab and the control group was 0.74 (95% confidence interval [CI]: 0.36–1.50) and 0.48 (95% CI: 0.31–0.74), respectively. This meta‐analysis showed that the risk of death in COVID‐19 patients who were treated with corticosteroids and tocilizumab was lower than the tocilizumab alone and control groups (26% and 52%, respectively).

P5‐47: Safety and efficacy of remdesivir, baricitinib and high‐dose steroid combination therapy in patients hospitalized with COVID‐19

P5‐47: Safety and efficacy of remdesivir, baricitinib and high‐dose steroid combination therapy in patients hospitalized with COVID‐19

Management of a Unique Presentation of a Common Dermatologic Condition.

CONTEXTSkin rashes are a common complaint seen in the primary care setting. There are many dermatologic conditions which a primary care provider (PCP) should be able to recognize and manage. One such condition is granuloma annulare (GA), which commonly presents as smooth, annular plaques on the trunk and/or extremities. Rashes like GA rarely present as unique variants and may be difficult for PCPs to determine from patient history and physical exam alone. Patch granuloma annulare (patch GA) is an example that may clinically mimic a cutaneous lymphoma known as mycosis fungoides (MF). PCPs should ideally be able to recognize the utility of performing a skin biopsy and/or referring the patient to a dermatologist when history and physical exam alone are insufficient. The histologic findings of skin biopsies often become essential in establishing a proper diagnosis and guiding patient management in unique dermatologic variants.EXAMPLE CASEThe patient in this clinical practice report is a Caucasian female in her late 60s who presented to a dermatology clinic with a two-year history of a worsening widespread eruption on her trunk and extremities. She had been evaluated previously by her PCP about 4 months prior and, without obtaining skin biopsies, treated her with a medium potency topical corticosteroid cream. The eruption had spread over her hips, buttocks, back, thighs, wrists, and elbows. Multiple skin biopsies of affected sites were taken by the second author and revealed findings consistent with patch GA. The patient was started on topical betamethasone dipropionate 0.05% ointment twice daily and noted marked improvement of her symptoms.CONCLUSIONSAlthough GA is a benign condition of the skin that may be readily detected by PCPs, skin biopsies may be necessary to establish a proper diagnosis when this condition presents as a unique variant (e.g., patch GA). Therapy for patch GA often begins with a trial of high-potency topical steroid therapy in combination with ultraviolet light exposure, depending on disease severity and patient preference. Early evaluation with a skin biopsy by her PCP or an earlier referral to a dermatologist to have skin biopsies performed likely would have helped establish a prompter diagnosis and treatment plan for this patient.

Combination therapy of Tocilizumab and steroid for management of COVID-19 associated cytokine release syndrome: A single center experience from Pune, Western India.

Cytokine release syndrome (CRS) or cytokine storm is thought to be the cause of inflammatory lung damage, worsening pneumonia and death in patients with COVID-19. Steroids (Methylprednislone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroid in COVID-19 associated CRS.This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India between April 2 and November 2, 2020. All patients administered TCZ and steroids during this period were included. The primary endpoint was incidence of all cause mortality. Secondary outcomes studied were need for mechanical ventilation and incidence of systemic and infectious complications. Baseline and time dependent risk factors significantly associated with death were identified by Relative risk estimation.Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. Thirty seven percent patients were managed in wards and did not need intensive care unit (ICU) admission. Infectious complications like hospital acquired pneumonia, blood stream bacterial and fungal infections were observed in 2.13%, 2.13% and 0.06% patients respectively. Age ≥ 60 years (P = .014), presence of co-morbidities like hypertension (P = .011), IL-6 ≥ 100 pg/ml (P = .002), D-dimer ≥ 1000 ng/ml (P < .0001), CT severity index ≥ 18 (P < .0001) and systemic complications like lung fibrosis (P = .019), cardiac arrhythmia (P < .0001), hypotension (P < .0001) and encephalopathy (P < .0001) were associated with increased risk of death.Combination therapy of TCZ and steroids is likely to be safe and effective in management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled trials.

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

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

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

Efficacy of combination therapy of steroid and methotrexate for refractory pemphigus

AbstractThe first line of treatment for pemphigus is systemic corticosteroids. When steroids alone do not result in remission, additional immunosuppressants are recommended. Twenty‐two patients with pemphigus vulugris were treated with steroids and other immunomodulators. However, they were refractory, and hence, methotrexate (MTX) was administered. The efficacy of MTX was assessed for 16 patients who were able to continue MTX therapy for 1 year. Steroid dose reduction was possible in 11 patients. One patient with severe infections had diabetes and was elderly. Our results suggested that MTX was useful as a steroid‐sparing agent in treating recalcitrant pemphigus, when an initial immunosuppressant treatment had failed. However, adverse effects should be closely monitored.

Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method

Background: Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective: The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods: Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2–3 months. Results: After 2–3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion: Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.

Oral Pulse Betamethasone, Methotrexate, and Combination Therapy to Treat Severe Alopecia Areata: A Randomized, Double-blind, Placebo-controlled, Clinical Trial.

The purpose of this study is to compare oral betamethasone pulse therapy, methotrexate therapy and a combination of the two for patients with Alopecia Areata (AA) as an autoimmune disorder. In this study, 36 patients with severe AA were selected and classified into three groups of 12: 1- Oral betamethasone therapy (3 mg, once a week) with placebo; 2- Oral methotrexate (15 mg, once a week) with placebo; and 3- A combination of methotrexate (15 mg, once a week) and betamethasone (3 mg, once a week). The Severity Alopecia Tool (SALT) was used to measure improvements in the lesions through photographs, and the patients also rated their condition on the Visual Analogue Scale (VAS). Assessments were performed, and the results were compared at baseline and then at intervals of three months for nine months. The demographics and SALT score were similar in the three groups (P > 0.05). All the groups showed improvements in SALT, VAS and photographic scores three months after beginning the treatment (P < 0.001). Betamethasone therapy (P = 0.006) and combination therapy (P < 0.001) provided greater SALT improvement than methotrexate, and combination therapy led to a greater improvement in VAS and photographic findings compared to the two other groups (P < 0.05). Oral steroid, methotrexate and combination pulse therapy were effective treatments for AA, while oral steroid pulse therapy and combination therapy were superior to methotrexate.