Combined Steroid Therapy Research Articles

Management of mucous membrane pemphigoid with dapsone plus weekly steroid injections in a young patient: a case report

PURPOSE: Mucous Membrane Pemphigoid (MMP) is an autoimmune subepithelial blistering disorder usually affecting older individuals. This paper describes the pharmacological management of MMP in a young patient. CASE DESCRIPTION: A 23 year-old woman showed erythematous ulcerative gingiva in the maxillary palatal region and around the retromolar region. A perilesional excisional biopsy was done, and the histologic and immunohistochemical analysis confirmed the clinical diagnosis of MMP as the cause of desquamative gingivitis in this patient. The patient was treated with topical steroids plus daily Dapsone 100 mg and weekly steroid injections (40 mg). The lesions began to resolve after 12 weeks of therapy. CONCLUSION: This case of MMP in a young female patient was effectively managed with a combination therapy of topical steroids, Dapsone and steroid injections.

Effect of steroid, carbogen inhalation, and lipoprostaglandin E 1 combination therapy for sudden sensorineural hearing loss

Purpose The purpose of this study was to evaluate the efficacy of combined therapy with steroid, carbogen inhalation, and lipoprostaglandin E 1 (lipo-PGE 1) treatment and compare the results with other treatment modalities in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Subjects and methods The study group consisted of 670 patients diagnosed with unilateral ISSNHL. Two hundred patients (DCP group) were treated with steroid, lipo-PGE 1 and carbogen inhalation combination therapy, 194 patients (DC group) with steroid and carbogen inhalation, and 276 patients (D group) with steroid medication only. The therapeutic effects of the treatment groups were evaluated 2 months after treatment, using pure tone averages. Siegel's criteria for hearing improvement were used for the assessments. Results The overall recovery rate after treatment was 57.5%. For each group, the recovery rate was as follows: 67.0% in the DCP group, 52.6% in the DC group, and 53.9% in the D group. The DCP group had a significantly better improvement rate than the other 2 groups. In addition, the DCP treatment was better than the other 2 groups for patients: less than 50 years of age, with an initial hearing loss less than 90 dB HL, had treatment started within 1 week from the onset of hearing loss, had tinnitus or an ascending type audiogram, and/or had no vertigo. Conclusion Steroid, lipo-PGE 1, and carbogen inhalation therapy was more effective than the other treatment modalities studied for patients with ISSNHL.

Prognostic relevance of clinical and histological features in IgA nephropathy treated with steroid and angiotensin receptor blockers

The prognostic relevance of clinical and histological features on renal outcome has not been assessed in patients with IgA nephropathy (IgAN) treated with the combination therapy of steroid and angiotensin receptor blockers (ARB). A prospective trial of a combination of steroid and ARB was performed in 50 patients with IgAN, proteinuria and serum creatinine levels < 2 mg/dl. Over a mean follow-up period of 4 years, the combination therapy reduced proteinuria and hematuria and improved renal function in most patients. The mean change in estimated GFR (eGFR) was + 0.30 +/- 0.74 ml/min/1.73 m2/month. Forty-three patients (86%) exhibited stable renal function and 7 patients (14%) reached the primary end point of a (3) 20% decrease in eGFR from baseline levels. Between the nonprogressive and progressive patients, there were significant differences in the levels of urine protein/ creatinine excretion ratio (PCR) at baseline and throughout the follow-up period as well as baseline eGFR and degree of glomerular crescents (p < 0.05). Forty (80%) and 24 patients (48%) had a urine PCR < 1 and < 0.3 g/g, respectively, at their last follow-up. Renal survival was better in patients who had initial urine PCR < 3 g/g as well as final PCR < 1 g/g. Regression analysis revealed that the final urine PCR and age were critical determinants of slope of the eGFR by both univariate and multivariate analyses. However, eGFR, pathologic findings, systolic BP, proteinuria, and body mass index at the initial presentation were not predictive of slope. Our results indicate that achieving a low urinary protein excretion is the main determinant for the good outcome in patients treated with combination therapy.

Hypertrophic pachymeningitis with MPO-ANCA-positive vasculitis

A 75-year-old man presented with headache, right facial palsy, and left hemiparesis. Because of elevated myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers and findings from magnetic resonance imaging (MRI) which were compatible with hypertrophic pachymeningitis (HP), he was diagnosed with MPO-ANCA-positive HP. He was treated with the combination therapy of steroid and cyclophosphamide (CY), leading to good prognosis. We present a case of HP associated with MPO-ANCA-positive vasculitis and emphasize the importance of MPO-ANCA tests as a predictable factor for relapse of the disease in order to start earlier treatment for the disease.

Long-term outcome of patients with polymyositis/ dermatomyositis and anti-PM-Scl antibody

To date, no series has analysed long-term outcome in patients with polymyositis/dermatomyositis (PM/DM) with anti-PM-Scl antibody. The aims of the present study were: (i) to assess clinical features and long-term outcome, including organ complications, functional course and mortality rate, in patients with isolated PM/DM with anti-PM-Scl antibody; and (ii) to evaluate prevalence, characteristics and long-term outcome of interstitial lung disease (ILD) in patients with isolated PM/DM with anti-PM-Scl antibody. The medical records of 20 consecutive patients with isolated PM/DM with anti-PM-Scl antibody were reviewed. Two patients (10%) achieved remission of PM/DM, whereas 14 (70%) improved and four (20%) had a worsened clinical status. Short-term recurrences (during tapering of therapy) occurred in nine patients and long-term recurrences (after discontinuation of therapy) in three patients. Moreover, patients with PM/DM with anti-PM-Scl antibody exhibited severe complications, as follows: oesophageal involvement (n = 4) requiring enteral feeding in three cases, ventilatory insufficiency (n = 3) requiring mechanical ventilation in two cases; three other patients had cancer. Interestingly, patients with PM/DM with anti-PM-Scl antibody often presented symptoms that are usually found in antisynthetase syndrome, i.e. hyperkeratotic rhagadiform hand symptoms (n = 2; 10%), Raynaud's phenomenon (n = 8; 40%), arthralgia/arthritis (n = 7; 35%) and ILD (n = 12; 60%). In our cohort, the associated ILD often required combined therapy of steroids and immunosuppressive agents. Our series suggests that the presence of anti-PM-Scl antibody is not a good prognostic factor in patients with PM/DM, as there appears to be an association with lung and oesophageal involvement; in addition, anti-PM-Scl antibody may coexist with malignancy in patients with PM/DM. Furthermore, anti-PM-Scl antibody-positive patients with PM/DM often exhibit 'mechanic's hands', Raynaud's phenomenon and joint involvement. Our latter findings raise the possibility that the immunogenetic background influences the autoantibody status of these patients; HLA-DR3 has, in fact, been found in association with antisynthetase syndrome antibodies and with anti-PM-Scl antibodies.

Role of intraocular steroids for the treatment of diabetic macular edema

Diabetic macular edema (DME) is a common and treatable cause of moderate vision loss. Since the introduction of focal/grid photocoagulation more than two decades ago, clinicians have been searching for alternative means to prevent further vision loss or improve the vision in eyes with DME, yet laser photocoagulation remains the standard of care. The most widely employed alternative treatment for DME has been the use of intravitreal corticosteroids. Although steroids can reduce the retinal thickening associated with DME, they are associated with adverse side effects such as elevated intraocular pressure and progression of cataract. Recently, a Phase III randomized clinical trial has shown that laser photocoagulation is superior to monotherapy with a preservative-free intravitreal steroid for the treatment of DME for 24 months. Depot steroid preparations, as well as combination therapy of steroid plus laser photocoagulation, are currently being investigated for the treatment of DME.

Diffuse proliferative glomerulonephritis associated with dermatomyositis with nephrotic syndrome

We described a 44-year-old man developing dermatomyositis (DM) and nephrotic syndrome (NS). Renal biopsy revealed diffuse proliferative glomerulonephritis (DPGN) with depositions of immunoglobulin and complements. A combination therapy of steroid and cyclophosphamide (CTX) was found very effective for the patient. Chronic glomerulonephritis is rare in DM. In our review of related literature, membranous glomerulonephritis (MN) is the main type of glomerular lesion, another type is mesangial proliferative glomerulonephritis (mesPGN). Here we reported a case of DM associated with DPGN developing NS, which was not found in existing literature. Although glomerulonephritis is uncommon in patients with DM, renal pathology is not as simplex as previously thought, and treatment with steroid or/and cytotoxic drugs is favorable for prognosis.

How long should the sudden hearing loss patients be followed after early steroid combination therapy?

To evaluate the beginning time and the completion time of hearing improvement in patients with sudden hearing loss who were treated with combination therapy including oral steroid. From September 2006 to December 2007, 102 idiopathic sudden hearing loss patients who showed any 'recovery' in hearing according to the Siegel's criteria after treatment were analyzed. Pure tone audiometries were performed on the pretreatment day and on the third, seventh, fourteenth post-treatment day, and on the first, second, third, sixth post-treatment month. The time of initial hearing improvement and the completion time of hearing improvement were analyzed. Of 102 patients who showed any improvement, cumulatively, 93.1% showed beginning of hearing improvement within 14 days after treatment. Complete recovery or an end of change was achieved in cumulatively 80.4% of the patients within 1 month after treatment and in 92.2% of the patients within 2 months after treatment. Prognosis can be predicted approximately 2 weeks after start of treatment because time of commencement shows plateau after 2 weeks in improved cases. Hearing should be followed-up for at least 2 months after treatment in patients who show incomplete or delayed hearing improvement.

Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: A comparative study

Previous studies have shown that topical steroid and shampoo containing zinc pyrithione provide clinical benefits for treatment of scalp seborrheic dermatitis. But the clinical efficacy of topical tacrolimus, a newly developed calcineurin inhibitor on seborrheic dermatitis, is not well investigated yet. We wanted to compare the clinical efficacy of topical tacrolimus with that of conventional treatment (zinc pyrithione shampoo and topical betamethasone) for treatment of seborrheic dermatitis of the scalp. Patients with seborrheic dermatitis of the scalp were randomly allocated to receive topical betamethasone, topical tacrolimus or zinc pyrithione shampoo. Some patients were instructed to continue the treatments for 8 weeks and the others to discontinue the treatments at week 4. We evaluated the efficacy using a clinical severity score, dandruff score and sebum secretion at baseline, week 4 and week 8. All treatment groups showed significant improvements in clinical assessment after 4 weeks. While the patients treated by zinc pyrithione improved continuously even after cessation of the treatment, the patients treated by betamethasone lotion or tacrolimus ointment were aggravated clinically. Topical tacrolimus was as effective as topical betamethasone, and showed more prolonged remission than topical betamethasone. To treat seborrheic dermatitis of the scalp, we think that the combination therapy of topical steroid or topical tacrolimus, and zinc pyrithione is recommended.

Achilles Tendon Rupture Associated with Combination Therapy of Levofloxacin and Steroid in Four Patients and a Review of the Literature

Achilles Tendon Rupture Associated with Combination Therapy of Levofloxacin and Steroid in Four Patients and a Review of the Literature

Clinical Profile, Treatment, and Visual Outcome of Serpiginous Choroiditis

The purpose of this study was to report the clinical profile and management of patients with serpiginous choroiditis in a tertiary care referral center in India. In a retrospective cohort study, 107 eyes of 70 patients with serpiginous choroiditis seen between January 1995 and December 2002 were analyzed. Systemic steroids and immunosuppressives were the mainstay of therapy. Antituberculous and antiviral drugs were used in selected cases. There was male preponderance (7:3). Age at presentation ranged from 11 years to 52 years (mean 30.3 ± 9 years); 52.9% had bilateral involvement. Vision improved or maintained in 86% eyes and deteriorated in 15 eyes (14%). The main cause of decrease of vision was macular involvement. Improvement in vision and resolution of lesions in patients with serpiginous choroiditis can occur with combination therapy of systemic steroids and immunosuppressive agents. Serial examination at regular intervals is needed to monitor the disease progression, recurrences, and involvement of the other eye.

Sudden sensorineural hearing loss: Long-term follow-up results

This study describes the long-term outcome of patients suffering from sudden sensorineural hearing loss (SSHL) after an initial combined therapy of steroids with vasodilators. Eighty cases were retrospectively reviewed to evaluate the long-term audiometric data and to statistically assess the value of specific clinical parameters. The persistent long-term otoneurologic manifestations associated with SSHL were also reported. In the long-term period, hearing level remained stable 2 months after the onset of SSHL. Patients complained of persistent tinnitus (36%), fluctuant hearing loss (8.7%), dizziness (8.7%), and classical Ménière's triad in 2.5% of cases. Profound and total SSHL associated with vertigo are poor prognostic indicators. In terms of cost-effectiveness, a steroid-vasodilator therapy for SSHL for >2 months is not recommended because no additional effect was evidenced. Persistent otoneurologic manifestations, mainly tinnitus or dizziness are relatively common, particularly in patients with severe to total SSHL. C-4.

A case of Wegener?s granulomatosis with pulmonary bleeding successfully treated with double filtration plasmapheresis (DFPP)

We report a case of a 41-year-old Japanese man who presented with rapidly progressive glomerulonephritis, chronic sinusitis, and positive cytoplasmic-antineutrophil cytoplasmic antibody (c-ANCA). Renal biopsy showed crescentic glomerulonephritis, and he was diagnosed as having Wegener's granulomatosis. During the clinical course, he suffered from pulmonary bleeding, and combination therapy of steroid, immunosuppressant, and double filtration plasmapheresis (DFPP) was started. He rapidly entered remission after assistance through DFPP, suggesting the potential efficacy of DFPP for Wegener's granulomatosis, especially with pulmonary bleeding.

Phytoestrogens: Implications in Neurovascular Research

The early discontinuation of the Women's Health Initiative trial evaluating the effects of estrogen plus progestin due to concerns about the risk-benefit ratio of this steroid combination therapy emphasizes the need to examine alternative methods of estrogen replacement. One such alternative is isoflavone consumption of soy-derived dietary phytoestrogens that have received prevalent usage due to their ability to decrease age related disease (cardiovascular and osteoporosis), hormone-dependent cancers (breast and prostate), and peri- and postmenopausal symptoms. Differences in dietary phytoestrogen consumption result in large variations in somatic phytoestrogen content. These molecules affect estrogen and estrogen receptor function in several ways, including having both agonist and antagonist effects on estrogen receptors, as well as functioning like natural selective estrogen receptor modulators. Similar to estrogens, dietary phytoestrogens appear to affect certain aspects of vascular, neuroendocrine, and cognitive function. This article reviews health effects of estrogen, isoflavones and their hormonal mechanism of action, brain penetration by isoflavones, heath effects of isoflavones, and effects of isoflavones on vascular, neuroendocrine, and cognitive function. Because of their diverse health effects and widespread availability in soy foods, dietary phytoestrogens merit continued research into their effects on human health and cognitive function.

Role of transtympanic steroids in idiopathic sudden sensorineural hearing loss

Objectives: To determine if the addition of transtympanic steroids to oral steroids improves hearing recovery in idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: Forty adults with unilateral sudden sensorineural hearing loss (defined as a loss of at least 30 dB in 3 contiguous frequencies within 72 hours) and no clinically identifiable etiology were included in this retrospective review. Patients were treated with either oral steroids alone, oral steroids in combination with transtympanic steroid therapy, and transtympanic steroids alone. Treatment with transtympanic steroids alone was restricted to patients with medical contraindications for systemic steroid therapy. In the majority of patients, transtympanic steroids were administered as a single injection of dexamethasone at the time of initial evaluation. Patients in the other 2 treatment groups were self-selected. Pre- and posttreatment audiometric results were compared. Results: Hearing outcomes in the 3 treatment groups were compared within groups and with each other to assess hearing recovery rates with each treatment modality and to determine if there was any benefit of transtympanic steroid therapy in combination with systemic steroids in ISSNHL. Fifty percent or less of patients in the oral only and oral/transtympanic steroid groups experienced partial or complete hearing recovery. Hearing outcomes were not significantly improved with the addition of transtympanic steroids. Conclusions: Our results suggest that the addition of transtympanic steroids, administered as single injections, does not seem to improve hearing outcomes in ISSNHL compared to treatment with systemic steroids alone.

Severe acute respiratory syndrome: clinical outcome and prognostic correlates.

Severe acute respiratory syndrome (SARS) poses a major threat to the health of people worldwide. We performed a retrospective case series analysis to assess clinical outcome and identify pretreatment prognostic correlates of SARS, managed under a standardized treatment protocol. We studied 127 male and 196 female patients with a mean age of 41±14 (range 18–83). All patients, except two, received ribavirin and steroid combination therapy. In 115 (36%) patients, the course of disease was limited. Pneumonitis progressed rapidly in the remaining patients. Sixty-seven (21%) patients required intensive care, and 42 (13%) required ventilator support. Advanced age, high admission neutrophil count, and high initial lactate dehydrogenase level were independent correlates of an adverse clinical outcome. SARS-associated coronavirus caused severe illnesses in most patients, despite early treatment with ribavirin and steroid. This study has identified three independent pretreatment prognostic correlates.

A retrospective review of Botulinum toxin type A compared with standard therapy in the treatment of lumbar myofascial back pain patients

The purpose of this study was to assess the safety and efficacy of Botulinum toxin type A (BTX-A, Botox®, Allergan, Inc) in reducing pain in patients with myofascial low back pain of the lumbar area, compared with the standard combination therapy of anesthetic and steroid in a 'real-life', office-based, clinical evaluation. This was a retrospective, single center clinical evaluation. Patients were randomly selected from patient lists for inclusion and no treatment was given or altered. The primary outcome variables were efficacy (as determined by the mean time between treatments, i.e. duration of effects), and change in pain scale scores. BTX A provided a significantly greater amount of time without pain than the anesthetic/steroid combination with a mean time between treatments of 189.11 ± 12.24 days following Botulinum toxin type A injections and a mean time of 70.43 ± 8.23 days following steroid injection therapy (p < 0.0001). There was also a significant reduction from the pre-treatment baseline in visual analogue scale scores for pain following Botulinum toxin type A injections (p = 0.002) but no significant difference for the anesthetic/steroid combination (p = 0.134). In conclusion, Botulinum toxin type A therapy resulted in a significantly greater amount of time spent with significant pain reduction compared with standard anesthetic/steroids.

The effectiveness of steroid treatment in nasal polyposis

Objective: The objectives of the management of nasal polyposis are to eliminate or reduce the size of polyps, reestablish nasal breathing, reduce symptoms of rhinitis, restore the sense of smell, and prevent the recurrence of nasal polyps. Local or systemic steroids have been used in the treatment of nasal polyps, but efficacy of combined (local and systemic) steroids in nasal polyposis has been little investigated. The aim of this study was to evaluate the influence of combined steroid therapy on the symptoms and extent of the disease in patients with nasal polyposis. Methods: Seventeen patients with nasal polyps were treated with combined steroids. Before and after the therapy, polyp size, nasal symptoms, sense of smell, and headache or facial pain were assessed by an established scoring system. Results: After the therapy, symptom scores of all the patients improved. Of the patients, 12% showed a polyp-free nasal cavity, 76% a clear involution of polyps, and 12% no response to the therapy. There were statistically significant differences ( P<0.001) for symptom scores and polyp size. Medical ablation of polyps using steroids was not achieved in 88% patients. Conclusion: Steroids can reduce polyp sizes and improve the symptoms, but are inadequate to eradicate the polyps. Surgery still plays a major part in the treatment of the nasal polyposis, but steroids can delay the necessity for surgical intervention.

Autoimmune hepatitis; What factors predict the response to combination therapy of azathioprine plus steroid

Autoimmune hepatitis; What factors predict the response to combination therapy of azathioprine plus steroid

The estrogen antagonist EM-652 and dehydroepiandrosterone prevent diet- and ovariectomy-induced obesity.

EM-652 is a pure antiestrogen in human breast and uterine cancer cells that also reduces bone loss and plasma lipid levels in the rat. This study aimed to assess the ability of EM-652, alone or with dehydroepiandrosterone (DHEA), to prevent obesity and related metabolic abnormalities induced by an obesity-promoting diet and ovariectomy. Female rats were fed a high-sucrose, high-fat (HSHF) diet, were left intact or ovariectomized (OVX), and were treated with EM-652, DHEA, or both for 20 days. Variables of energy balance and determinants of lipid metabolism and insulin sensitivity were assessed. The HSHF diet (vs. chow) and OVX both increased energy intake and gain, as well as energetic efficiency. Both EM-652 and DHEA prevented diet- and OVX-induced energy gain mainly by decreasing fat deposition, without being additive. The modest EM-652-induced increase in liver triglycerides of intact rats was prevented by its combination with DHEA. EM-652, but not DHEA, decreased cholesterolemia. The HSHF diet and OVX reduced insulin sensitivity, an effect that was attenuated by EM-652 and abrogated by DHEA and EM-652+DHEA. Treatment with EM-652, DHEA, or their combination abolished the diet- and OVX-induced increase in adipose lipoprotein lipase activity that accompanied fat gain. EM-652 is an effective agent to prevent diet- and OVX-induced obesity and its associated cardiovascular risk factors such as insulin resistance. The addition of DHEA prevents hepatic lipid accumulation and further ameliorates insulin sensitivity. The beneficial metabolic effects of such combined steroid therapy may, therefore, eventually prove to be clinically relevant.