Steroid Treatment In Patients Research Articles

Optimal time for the addition of non-corticosteroid immunosuppressants in myasthenia gravis: a single-center retrospective study in China

IntroductionPatients with myasthenia gravis (MG) display strong treatment heterogeneity. Recent studies have indicated that low-dose steroids or immunosuppressants are effective. However, factors affecting the add-on of non-corticosteroid immunosuppressants to corticosteroids remain unknown.MethodConsecutive patients with MG were retrospectively reviewed from May 15, 2015, to December 29, 2020. We included one group of patients with steroid treatment alone and another group who transitioned to non-steroid immunosuppressant therapy. Clinical features of the included patients were analyzed. Univariate and multivariate Cox regression models were used to identify potential influential factors.ResultsA total of 107 patients with MG were analyzed, including 66 receiving corticosteroid treatment alone and 41 who subsequently also received non-corticosteroid immunosuppressant therapy. Eight potential factors were primarily selected in univariate analysis (Ps < 0.1). Achieving minimal symptom expression (MSE) within 6 months (HR: 4.424, 95%CI: 2.102–11.865), body mass index (BMI) (HR: 0.385, 95% CI: 0.186–0.797), quantitative MG (QMG) bulbar muscle score (HR: 1.553, 95% CI: 1.140–2.118), disease duration (HR: 0.987, 95% CI: 0.977–0.997) and relapse (HR: 2.638, 95% CI: 1.031–6.750) were finally identified as potential influencing factors.DiscussionWe found multifactorial clinical factors were highly associated with the add-on of non-steroid immunosuppressants after steroid treatment in patients with MG. Achieving MSE within 6 months, BMI, QMG bulbar muscle score at baseline before steroid treatment, disease duration, and disease relapse may represent crucial influencing factors, which should be considered to improve the long-term prognosis for patients with MG in future studies and practice.

Short-term results of steroid treatment in patients with non-arteritic ischemic optic neuropathy

Aims: To evaluate the effects of steroid treatment on the best-corrected visual acuity (BCVA) and retinal nerve fiber layer (RNFL) in patients with non-arteritic ischemic optic neuropathy (NAION). Methods: The retrospective study included 24 eyes of 24 patients who received 1 gram/day pulse steroid treatment for 3 days with a diagnosis of NAION. The patient's comorbidities, demographic information, intraocular pressure, BCVA, and RNFL measured by optical coherence tomography (OCT) were recorded before and after treatment at one month. Results: The mean age of the patients was 64.35±14.6 (22-86). Diabetes mellitus was present in 14 patients (58.3%), hypertension in 13 (54.2%), and coronary artery disease in 5 (27.8%). The pre-treatment BCVA was 0.33±0.37, and post-treatment BCVA was 0.37±0.36 (p=0.345). The pre-treatment RNFL value was 208.0±57.9, and the post-treatment RNFL value was 113.6±32.6 (p<0.000). No additional complications related to treatment were observed. Conclusion: While there was no significant difference in BCVA values one month after steroid treatment, a significant anatomical improvement was observed in RNFL thickness.

Effect of early high-dose steroid treatment in patients with acute vestibular neuritis: a retrospective case-control study

Effect of early high-dose steroid treatment in patients with acute vestibular neuritis: a retrospective case-control study

Ozone therapy as a novel complementary therapeutic approach in refractory idiopathic granulomatous mastitis.

Autoimmunity may play a major role in the pathogenesis of idiopathic granulomatous mastitis (IGM). The therapeutic potential of ozone therapy has recently been shown in rheumatological diseases, and this study aimed to assess the clinical efficacy of ozone therapy (OT) in refractory IGM. Patients with biopsy-verified IGM and incomplete response after steroid therapy (n = 47) between 2018 and 2021 were enrolled. Of these, 23 cases in cohort A had standard treatment with further steroid therapy (ST), and 24 were treated with systemic OT via autohemotherapy (AHT) in addition to steroid therapy (cohort B). The median age was 33 years (range, 24-45). Patients in cohort B had a higher complete response rate after completion of a four-month ozone therapy than those in the ST-group (OT-group, 37.5% vs. ST-group, 0%; p = 0.002). At a median follow-up of 12 months (range, 12-35), the patients treated with OT had a lower one-year recurrence in the affected breast than cases in cohort A treated with ST (OT-group, 21% vs. ST-group, 70%; p = 0.001). No significant side effects were observed in patients in cohort B related to AHT. Furthermore, OT significantly decreased the total steroid treatment duration (median week of steroid use; 26 weeks in cohort A vs. 12 weeks in cohort B; p = 0.001). Systemic OT increases the complete response rate and decreases the duration of steroid treatment in patients with refractory IGM. Therefore, ozone therapy is an effective, well-tolerated, and safe novel complementary therapeutic modality.

Intratympanic treatment in chronic subjective tinnitus

Aims: The aim of our study was to determine the efficacy of this treatment by evaluating the results of pure-tone audiometry, tinnitus rating scale, and tinnitus handicap questionnaire performed before and after intratympanic (IT) steroid treatment in patients with chronic subjective tinnitus who were not treated despite receiving medical treatment. Settings and Design: Twenty-three patients between 27 and 79 years of age who had normal physical examination had tinnitus complaints at least 3-month duration and who had been treated with IT steroid treatment were enrolled to the current study. Patients smaller than 18 years of age, patients with mental, neurological and psychological pathology, patients who had used any kind of medical treatment for tinnitus in the past 3 months, were excluded from the study. Subjects and Methods: The study included patients who were admitted to Mersin University Medicine Faculty Otorhinolaryngology Department, Department with tinnitus and were treated with IT steroid treatment. Written informed consent was obtained from all patients participating in the study. Statistical Analysis Used: All analyses were performed using IBM SPSS 22 package software trial version. The normal distribution of the data was examined with Shapiro–Wilk test. Frequency and percentage were calculated for categorical values. Results: In the tinnitus grading scale, a significant decrease in before and after treatment was determined for 17 patients with tinnitus complaints and was found statistically significant (P < 0.001). The results of tinnitus handicap questionnaires were rated between 21.4 and 69.6 for before treatment and between 11.4 and 63.6 for after treatment and were found statistically significant (P < 0.001). Conclusion: In this study, we found that IT steroid treatment decreased both tinnitus rating scale and tinnitus handicap scores for patients with chronic idiopathic tinnitus without hearing loss.

Steroid treatment in patients with acute respiratory distress syndrome: a systematic review and network meta-analysis.

PurposeAlthough the most recent systematic review and meta-analyses on acute respiratory distress syndrome (ARDS) have shown that the use of steroids decreases mortality in adult patients, its benefits and risks may differ depending on the type and dosage of the steroid. Therefore, we conducted a network meta-analysis (NMA) to compare the differences in the efficacy among different doses and types of steroids.MethodsWe searched MEDLINE, CENTRAL, ICHUSHI, ClinicalTrials.gov, and WHO ICTRP databases from the earliest records to March 2021 for randomized control trials, which compared steroids with placebo or conventional therapy for ARDS. Using the random-effects model, we compared various categories of steroids (high-dose methylprednisolone, low-dose methylprednisolone, hydrocortisone, dexamethasone, and no steroid) concerning hospital mortality, incidence of infection, and ventilator-free days (VFD).ResultsWe analyzed nine studies involving adult patients (n = 1212). Although there were no significant differences between the groups in terms of the mortality and incidence of infection, the number of VFD were greater when using low-dose methylprednisolone than when not using any steroids (Mean difference: 6.06; 95% confidence intervals: [2.5, 10.5]). Moreover, the rank probability showed that low-dose methylprednisolone might be the optimal treatment, whereas using no steroid or high-dose methylprednisolone may be inferior to other treatments in terms of mortality, infection, and VFD.ConclusionThis NMA suggested that the effect of steroids on the outcome in patients with ARDS might depend on the type of the steroid drug administered. Moreover, further studies are needed to identify the optimal type and dosage.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00540-021-03016-5.

Meta-analysis of the Effectiveness of Steroid Pulse Therapy in Treating Patients with Spinal Cord Injury

Background: High-dose steroid injection therapy is effective in reducing anti-inflammation and edema and is often used to treat patients with acute spinal cord injury. To evaluate the effectiveness of steroid pulse therapy and identify the factors that affect its effectiveness in patients with acute traumatic spinal cord injury. Methods: A comprehensive literature search of the databases Pubmed, Medline, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL was performed on July 31, 2019, with no language and time limits. For analysis, studies conducted within the last 10 years were included to reflect on the recent trend. Results: A total of 3 randomized controlled trials and 5 observational studies with 2418 patients were included in this meta-analysis. High-dose steroid injection therapy was found to have a high effect on patients with acute spinal cord injury. The following factors had a strong influence on the effectiveness of high-dose steroid treatment in patients with acute spinal cord injuries: injury, onset ASIA, onset neurological assessment scales, time to start treatment after injury, age, BMI, and gender. Conclusion: It is necessary to accurately assess the scope of spinal injury in the early stages and actively provide nursing interventions to identify and mediate factors affecting the treatment effect.

P568 Effectiveness of ustekinumab after vedolizumab failure in patients with anti-TNF-refractory Crohn’s disease

Abstract Background Both vedolizumab (VDZ) and ustekinumab (UST) are indicated in the treatment of Crohn’s disease (CD) when anti-TNF treatment fails. While there are some studies regarding the efficacy of these two drugs in this setting, data are lacking regarding the effectiveness of UST in the treatment of VDZ-refractory disease. We aim to address this particularly challenging clinical picture in a real-world single-centre study. Methods CD patients from a single tertiary IBD referral centre receiving treatment with UST after failure to VDZ with a minimum follow-up period of 6 months were included. All patients had previously failed anti-TNF treatment. The primary outcome measure was achievement of steroid-free clinical remission, defined as HBI &amp;lt; 5 at 6 months. We also assessed rates of partial response, defined as a reduction in HBI by ≥ 3 points and/or cessation of steroid treatment in patients who required corticosteroids at baseline for symptom control. Results A total of 32 patients (20 male, mean age ± SD 40.7 ± 14.2, range 21–75) receiving UST treatment after VDZ failure were analysed. Complete steroid-free clinical remission at 6 months from starting UST therapy was achieved in 19 patients (59.4%). Nine patients (28.1%) had partial response, while in the remaining 4 patients (12.5%) no response was achieved. No adverse events were recorded during the follow-up period. Conclusion Preliminary results suggest that UST is effective and safe in the treatment of VDZ-refractory CD.

Intratympanic steroid injection versus hyperbaric oxygen therapy in refractory sudden sensorineural hearing loss: a meta-analysis.

The present meta-analysis aims to compare the efficacy of intratympanic steroid (ITS) injection and hyperbaric oxygen (HBO) therapy as salvage treatments for refractory sudden sensorineural hearing loss (SSNHL). Comprehensive searches were performed in PubMed, EMBASE and the Cochrane Library from the date of the database inception to June 2020. All studies reporting the use of salvage ITS and HBO treatments in refractory SSNHL patients were included. Subsequently, the full texts of the eligible studies were evaluated. The quality and bias of the studies were assessed using the Newcastle-Ottawa Scale and Cochrane's risk of bias tools for nonrandomized and randomized studies, respectively. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). Three hundred and fourteen subjects in 3 observational studies and 1 randomized controlled trial met our inclusion criteria. The pooled results demonstrated that there were no significant differences in the mean posttreatment hearing gain between the ITS and HBO groups. The changes in word discrimination and hearing gain at 250, 500, 1000, 2000, 4000 and 8000Hz were also comparable between the two salvage treatment groups. The pooled results demonstrated that there were no significant differences in hearing improvements between salvage ITS injection and salvage HBO therapy after failed primary systemic steroid treatment in patients with SSNHL. However, spontaneous recovery could bias the treatment outcomes, and these results should be interpreted with caution. Clinicians may choose these salvage treatments according to personal experience and treatment availability. In cases in which specialized HBO facilities are difficult to access, salvage ITS injection can be provided with comparable responses.

Serum food-specific Immunoglobulin G4 (sIgG4) levels decrease after steroid treatment in Eosinophilic Esophagitis (EoE)

Recent research has demonstrated higher food sIgG4 levels in patients with EoE. There is little information on whether sIgG4 levels correlate with disease activity. Our objective was to compare food sIgG4 levels before and after swallowed steroid treatment in patients with EoE.

Histology and immunohistochemical evaluation of phimotic prepuce: The role of steroid therapy

Phimosis is one of the most frequent andrological diseases in paediatric age. Steroids are useful to treat phimosis. Through a retrospective study of histological and immunohistochemical analysis, we evaluated the effectiveness of topical steroid treatment in patients undergoing circumcision. Cases of patients treated for phimosis were selected during the two-year study period. All patients underwent circumcision and were divided into four groups: groups A (religiously circumcised patients), B (phimotic patients not undergoing steroid treatment), C (phimotic patients who do not respond to cortisone treatment) and D (hypospadic patients undergoing urethroplasty). An histological evaluation of the degree of fibrosis and an immunohistochemical evaluation of collagen IV and tenascin were carried out. Study results demonstrate that the grade of fibrosis is age-related. On histological and immunohistochemical evaluation, fibrosis was found to be lower in patients receiving steroids; higher degrees of fibrosis were found in older patients (p<.05). Different degrees of fibrosis have also been found in hypospadic patients. We can conclude that study results correlated with the clinical history of the patients. The success rate of medical therapy seems to be age-related.

Tocilizumab and steroid treatment in patients with COVID-19 pneumonia.

Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome. This observational single-center study included patients with COVID-19 pneumonia who were not intubated and received either standard of care (SOC, controls) or SOC plus early (within 3 days from hospital admission) anti-inflammatory treatment. SOC consisted of hydroxychloroquine 400mg bid plus, in those admitted before March 24th, also darunavir/ritonavir. Anti-inflammatory treatment consisted of either tocilizumab (8mg/kg intravenously or 162mg subcutaneously) or methylprednisolone 1 mg/kg for 5 days or both. Failure was defined as intubation or death, and the endpoints were failure-free survival (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HROW). Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO2/FiO2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HROW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HROW 0.41, 95%CI: 0.19-0.89, p = 0.025. Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.

Efficacy of Various Corticosteroid Treatment Modalities for the Initial Treatment of Idiopathic Sudden Hearing Loss: A Prospective Randomized Controlled Trial

Objective: To evaluate the efficacy of systemic and intratympanic steroid treatment in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: Ninety patients who met the inclusion criteria were randomly divided into 3 groups (n = 30 per group). Group I patients were given oral methylprednisolone (MEPD) tablets, group II received intravenous MEPD injection, and group III received intratympanic MEPD injection. Pure-tone average (PTA) hearing threshold was recorded before and after treatment as well as 1 month later. The general efficacy rate was the ratio of patients whose hearing improved by >10 dB in each group. Results: Thirty-two of the 60 patients (53.3%) in groups I and II together showed a hearing improvement of >10 dB hearing level (HL) in the pure-tone audiogram, compared to 21 patients (70%) in group III, respectively. The mean improvements were 16.1, 14.3, and 21.6 dB HL measured in Groups I, II, and III, respectively. Both the general efficacy rate and hearing improvement were significantly greater in group III than in groups I and II. Conclusions: Our study showed that intratympanic injection rendered better treatment efficacy than systemic administration.

Comparisons among vestibular examinations and symptoms of vertigo in sudden sensorineural hearing loss patients.

Vertigo in sudden sensorineural hearing loss (SSNHL) is hypothesized as an extension of the disease caused by the anatomical proximity of the cochlea and vestibule. The present study aimed to demonstrate the association of vestibular function test (VFT) results with SSNHL disease severity and prognosis. This study assessed clinical records of 263 SSNHL patients admitted to our hospital, between January 2010 and October 2017. Steroid treatment comprised high-dose intravenous dexamethasone (16mg/d) or oral methylprednisolone (64mg/d) for 4days and tapered oral methylprednisolone for 8days after discharge. Caloric tests were performed in all patients, and cervical vestibular-evoked myogenic potential (c-VEMP) and ocular VEMP (o-VEMP) tests were performed in 209 and 144 patients, respectively. Ninety six patients had vertigo, and caloric abnormalities were observed in 119 patients. Initial PTA in patients with vertigo were worse than in those without vertigo (63.0dB vs 72.7dB, P=.002). Initial PTA in patients with abnormal o-VEMP was worse than in those with normal o-VEMP (61.4dB vs 73.0dB, P=.004). PTA improvement after steroid treatment in patients with vertigo was lower than in those without vertigo (25.0dB vs 20.9dB, P=.028). PTA improvement after treatment in patients with abnormal caloric results was lower than in those with normal caloric results (26.0dB vs 18.4dB, P=.013). The functions of vestibular organs, particularly the utricle and lateral semicircular canal, are associated with disease severity and hearing outcome in SSNHL patients.

The effect of steroid treatment on whiplash associated syndrome: a controlled randomized prospective trial.

There is significant evidence in the literature that low or relatively low cortisol concentrations near the time of an accident are associated with more severe forms of whiplash-associated disorders. We hypothesized that treating patients that were involved in a motor vehicle accident with hydrocortisone would alleviate the incidence and severity of these disabling disorders. A prospective, randomized, double-blind, placebo-controlled clinical trial. Blunt trauma patients that underwent a motor vehicle crash were allocated into a study group that received a single bolus of hydrocortisone and a control group that received saline. The patients were followed for 1month. The incidence and severity of whiplash associated disorder, functional disturbances, and post-traumatic stress disorder were compared between the two groups. The analyses were repeated for sub-divisions into groups of high and low admission cortisol. The more severe forms of whiplash-associated disorders on the day of accident were associated with low cortisol levels; mean cortisol concentration of the lower grade of whiplash patients (13.09 ± 7.35µg%) was higher than that of whiplash syndrome of the severe forms (8.33 ± 3.45µg), p = 0.001. There were no differences between study and control groups regarding whiplash-associated disorders, functional tests, and severity of stress disorder 1month after the accident. Significant differences were evident between high and low cortisol sub-groups. Those who had low cortisol level on admission and received hydrocortisone had worse outcomes. Steroid treatment of patients with whiplash might be harmful to those who present with low cortisol concentrations (< 9.5μg/dL). Clinical Trials: Association between low cortisol levels and whiplash syndrome. Date of registration: March 18, 2014. Date the first participant was enrolled: May 10, 2014. NCT02090309. URL: https://clinicaltrials.gov/ct2/show/NCT02090309 .

Quantitative MRI as marker of the effectiveness of steroid treatment in patients with Duchenne muscular dystrophy

Due to development of new methods for the treatment of Duchenne muscular dystrophy (DMD), aimed at suppressing inflammatory activity in skeletal muscles, there is a necessity for objective instrumental methods for assessing the effectiveness of the therapy. This method could be selective excitation of the water T2 signal.&#x0D; Aim of the study: to determine the possibility of applying the method of selective excitation of water T2 signal as a quantitative biomarker of the effectiveness of steroid treatment in patients with DMD at different stages of the disease. The study involved 34 DMD boys, who were divided into three groups: ambulant patients taking steroid treatment (n = 14), steroid-naive ambulant patients (n = 10), steroid-naive non-ambulant patients (n = 10) and a control group (n = 10). MRI of the pelvic girdle, thighs and lower legs with multi-slice-multi-echo (MSME) sequences has been done for all subjects. Calculation of the water T2 values has been done by the three-exponential method.&#x0D; Results: There was a significant difference (p 0.01) between the three study groups, the highest inflammatory activity was determined in the steroid-naive patients and signal intensity was 39.4 1.0 ms for the pelvic girdle muscles, 37.3 1.1 ms for the thighs muscles and 38.1 1.8 ms for the legs muscles. Thus, using of the technique of selectively determination of the signal from water on T2 weighted images can be quantitative biomarker of inflammatory activity and the effectiveness of steroid treatment in patients with Duchenne muscular dystrophy in different stages

Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma

Autoimmune pancreatitis (AIP) is an inflammatory process of the pancreas that occurs most commonly in elderly males and clinically can mimic pancreatic adenocarcinoma and present with jaundice, weight loss, and abdominal pain. Mass-forming lesions in the pancreas are seen in the focal form of AIP and both clinical and imaging findings can overlap those ofpancreatic cancer. The accurate distinction of AIP from pancreatic canceris of utmost importance as it means avoiding unnecessary surgery in AIP cases or inaccurate steroid treatment in patients with pancreatic cancer. Imaging concomitantly with serological examinations (IgG4 and Ca 19-9) plays an important role inthe distinction between these entities. Characteristic extra-pancreatic manifestations as well as favorable good response to treatment with steroids are characteristic of AIP. This paper will review current diagnostic parameters useful in differentiating between focal AIP and pancreatic adenocarcinoma.

Issue Highlights

Issue Highlights

Hypopituitarism associated with autoimmune pancreatitis: a case report

We herein report the case of a 64-year-old male patient with hypopituitarism associated with autoimmune pancreatitis (AIP). The patient was previously diagnosed with AIP based on the presence of a swollen pancreas, elevated serum immunoglobulin G4, and narrowing of the pancreatic duct by imaging. Magnetic resonance imaging revealed a pituitary stem tumor, and loading test showed a decrease in the function of the anterior lobe suggesting severe failure of growth hormone secretion. Treatment with steroids was effective in reducing the pituitary lesion and improving the function of the anterior lobe. The present case illustrates the importance of pituitary function evaluation before steroid treatment in patients with AIP.

Steroid treatment in patients with acute-on-chronic liver failure precipitated by hepatitis B: A 10-year cohort study in a university hospital in East China.

To investigate retrospectively the efficacy of steroids in patients with acute-on-chronic liver failure (ACLF) precipitated by hepatitis B. Patients with ACLF precipitated by hepatitis B were included and categorized according to treatment modalities (steroid vs. control). Survival and clinical characteristics, including patients' age, baseline ACLF grade, the model for end-stage liver disease (MELD) score, and occurrence of infection were compared between the two groups. Survival analyses of subgroups classified by their age, ACLF grade and MELD score were performed. Cox regression analyses were conducted to identify factors associated with 60-day cumulative and transplant-free mortality. From 2007 to 2016, 293 patients with hepatitis B-precipitated ACLF were recruited, among whom 162 received at least five consecutive doses of corticosteroids. By day 60 transplant-free survival was 62.6% in the control group compared with 53.7% in the steroid group (P = 0.126). Steroid treatment failed to show a survival benefit in the survival analysis among the subgroup. Within 60 days, pulmonary and overall infections occurred with higher frequency in the steroid-treated group than in the controls (P = 0.003 and < 0.001, respectively). In the univariate analysis, age, baseline MELD score >20, CLIF consortium (CLIF-C) ACLF grade 2-3, pulmonary infection and overall infection were associated with 60-day mortality. In the multivariate analysis, older age, baseline MELD score >20 and CLIF-C ACLF grade 2-3 were independent risk factors of 60-day mortality. Steroid treatment did not improve transplant-free survival in patients with ACLF precipitated by hepatitis B.