Use Of Steroids In Patients Research Articles

Comparing Intracanalicular and Topical Steroid Use in Patients Undergoing Pterygium Surgery.

The study received funding from Ocular Therapeutix, Inc., Bedford, MA.We undertook this study to compare the efficacy of intracanalicular dexamethasone 0.4 mg with topical prednisolone acetate (PA) 1% in controlling postoperative pain and inflammation in patients undergoing pterygium surgery. This was an open-label, prospective, interventional, nonrandomized comparative trial. Thirty patients were assigned to one of the following groups: Group A [intracanalicular insert of 0.4 mg dexamethasone placed into upper and lower puncta during the procedure, followed by at postoperative month 1 visit institution of topical PA 1% twice daily × 2 weeks then once daily × 2 weeks] or Group B [nonintervention group with institution on postoperative day 1 topical PA 1% every 2 hours × 2 weeks then four times per day × 2 weeks then twice daily × 2 weeks then once daily × 2 weeks]. Fifteen cases and 15 controls were enrolled. There was no statistical difference in patient-reported pain or satisfaction between the case and control groups at 1 day; 1 week; and 1, 3, and 6 months postoperatively. There was no significant difference in time to an ocular hyperemia score of 0 between the two groups. There was no difference in the rate of corneal reepithelialization and recurrence rate (two controls). Nine eyes had transient ocular hypertension (seven cases and two controls). Intracanalicular dexamethasone 0.4 mg may reduce the medication burden for patients who need prolonged postoperative steroid therapy as is routine in the setting of pterygium surgery. It is a safe and effective alternative to PA 1% drops alone for postoperative control of pain and inflammation in pterygium surgery.

P833 Burden of steroid use in patients with moderate ulcerative colitis in Europe and the United States

Abstract Background Steroids are an effective short-term therapy option for induction of remission of ulcerative colitis (UC). However, long-term and frequent steroid use is common in clinical practice despite the risks of complications and adverse events.1 We aimed to describe disease burden in moderate UC patients (pts) based on their steroid use history. Methods Data were drawn from the Adelphi UC Disease Specific Programme™, a cross-sectional survey of gastroenterologists (GIs) and their pts in France, Germany, Italy, Spain, the UK and US from Jan 2020–Mar 2021. GIs reported patient demographics, clinical characteristics, treatments and healthcare resource utilization (HCRU). Pts reported quality of life (QoL) via the EQ-5D, short inflammatory bowel disease questionnaire (SIBDQ), and work productivity and activity impairment (WPAI) questionnaire. Pts had received 5-ASA or immunomodulator with no biologic or Janus kinase inhibitor in the 90 days following treatment initiation, had a history of physician-assessed moderate disease severity or a Mayo endoscopic subscore of 2, and no history of colectomy. Pts were categorized as: no steroids (NS; never received steroids), short term/intermittent (ST/I; currently receiving intermittent steroids or received steroids within the last two years for <90 days), or long term/escalated (LT/E; received steroids for ≥90 days within the last two years or had undergone steroid dose escalation within their current course). Analyses were descriptive. Results Overall, 217NS, 88 ST/I and 172 LT/E pts were analysed (Table 1). Median (interquartile range) total steroid use duration was 4.1 (1.6–22.3) months for ST/I and 14.9 (5.8–36.7) months for LT/E. NS (24.4%), ST/I (25.0%) and LT/E (26.2%) pts experienced abdominal pain; 0.5%, 4.6% and 5.2% had severe/extremely severe pain, respectively. Non-bloody diarrhoea was reported by 16.6%, 14.8%, 20.9% of pts, respectively. In the last 12 months, mean (standard deviation; SD) number of health care visits for NS, ST/I and LT/E was 6.1 (6.2), 7.3 (4.8), 8.0 (7.1); mean (SD) number of tests was 20.8 (17.2), 23.3 (15.7), 25.2 (18.2), respectively. NS, ST/I and LT/E patients reported mean EQ-5D scores (0.85, 0.81, 0.79), SIBDQ total scores (54.6, 49.7, 48.3) and overall work impairment (19.4, 23.1, 27.7). Key comorbidities experienced by ST/I and LT/E were hypertension, depression and diabetes (Figure 1). Conclusion Patients with long-term or escalated steroid use had high symptom burden, frequent comorbidities, high HCRU, and poor QoL. This highlights the need for alternative treatment approaches for moderate UC patients to avoid long-term steroid use. 1. Cross R.K. Inflamm Bowel Dis. 2017;23(10):1689–1701

Preoperative Chronic Steroid Use is Associated with Increased Incidence of Postoperative Mortality and Limb Loss following Peripheral Arterial Bypass Surgery for Chronic Limb Threatening Ischemia

Steroids are a commonly prescribed medication in the United States and have been associated with poor surgical and treatment outcomes. The objective of this study is to assess the relationship between chronic steroid use and surgical outcomes of femoropopliteal and femoral-distal bypasses in patients suffering from chronic limb threatening ischemia (CLTI). All adult patients undergoing femoropopliteal and femoral-distal bypasses with single segment autologous vein with an indication of CLTI in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) between 2012 and 2021 were stratified between chronic preoperative steroid use (Group I) and no preoperative use (Group II). Primary outcomes of the study included 30-day mortality, amputation, and combined outcome of mortality and/or limb loss. Secondary outcomes included specific bypass related, cardiovascular, respiratory and renal outcomes. A total of 8,324 patients (66.8% Male, 33.2% Females) underwent peripheral arterial bypass operations for the indication of chronic limb threatening ischemia. The median age was 68 years. Group I included 408 patients (4.9%) and Group II included 7,916 patients (95.1%). As compared to patients in Group II, those in Group I were more likely to be females (Group I: 42.2% vs. Group II: 32.8%), more likely to have co-existing COPD (Group I: 20.6% vs. Group II: 11.8%), less likely to be diabetic (Group I: 45.9% vs. Group II: 48%), less likely to be smokers (Group I: 30.6% vs. Group II: 45.4%) and more likely to be in ASA III or IV Classes (Group I: 98% vs. Group II: 96.5%) (all p<0.05). Primary outcomes were as follows: 30-day mortality (Group I: 3.3% vs. Group II: 1.7%), amputation (Group I: 5.9% vs. Group II: 2.8%), 30-day mortality and/or amputation (Group I: 9.1% vs. Group II: 4.5%) (all p<0.05). Among secondary outcomes, the following were found to be statistically significant: untreated loss of patency (Group I: 4.2% vs. Group II: 1.7%), significant bleeding (Group I: 26.2% Vs. Group II: 16.5%), wound infection/complication (Group I: 18.6% vs. Group II: 15%), and return to OR (Group I: 21.8% vs. Group II: 16.7%) (all p<0.05). As compared to patients with an indication of tissue loss (Rutherford's class V and VI), patients in Group I with an indication of rest pain (Rutherford's class IV) were more likely to experience 30-day mortality, major amputation and a composite of mortality and amputation. Risk adjusted analysis showed that chronic steroid use has a statistically significant effect on 30-day mortality (AOR 1.7, p=0.05), amputation (AOR 2.05, p<0.001), composite outcomes of mortality and amputation (AOR 1.959, p<0.001), untreated loss of patency (AOR 2.31, p=0.002), bleeding (AOR 1.33, p<0.011) and unplanned return to the OR (AOR 1.36, p=0.014). Chronic steroid use in patients undergoing femoropopliteal or femoral-distal bypass is associated with a higher risk of 30-day mortality, major amputation, readmission, bleeding, return to operating room, and untreated loss of patency. No significant difference in outcomes were appreciated in patients with chronic steroid use and with Rutherford class V or VI disease (tissue loss), suggesting that the effects of steroids may be less prominent in those with the most advanced peripheral arterial disease. These findings may aid physicians with risk stratification and preoperative discussions regarding open revascularization in patients receiving chronic steroid therapy. More studies including randomized trials are needed to guide perioperative management of steroids in this cohort.

Hematologic Response to Steroid Use in Patients with Primary Immune Thrombocytopenia: A Research Study in a Salvadoran Population

Introduction. Thrombocytopenia Immune (ITP) is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is one of the more common causes of thrombocytopenia in otherwise asymptomatic adults. The use of high-doses dexamethasone has proven efficacy and safety in previously untreated patients with immune thrombocytopenia even though these findings are not entirely clear yet. AIM. The primary goal to assess the global response (platelets &amp;gt;30 x 109/L) and complete response (platelets &amp;gt;100 x 109/L) within the different implemented regimes in previously untreated adult with primary immune thrombocytopenia. Further goals aimed to describe the clinical characteristic of patients with primary immune thrombocytopenia and the most frequent adverse events in the use of steroids. Results. A total of 44 patients were treated with steroids, 16 patients in the high-dose dexamethasone (HD-DXM) group, 23 patients received methylprednisolone (MTP) and 5 patients with prednisone (PDN). The female gender was the most affected in all the groups with 61.3% (n=27) presenting more cases than the female sex in the methylprednisolone group 65.2% (n=15), although without significant statistical difference (P = 0.384). The mean age of onset was 38, 44, and 40 years, respectively (P = 0.352). The most frequent clinical manifestations were purpura sicca (petechiae and bruising) with 75%, 91.3% and 60.0%, for the dexamethasone, methylprednisolone and prednisone groups, respectively. The mean platelet count in the groups was around the mean of 26 x 109/L, with the methylprednisolone group presenting the lowest values (3 x 109/L). The overall response was different for the three groups (87.5% vs 95.6% vs 100%, P = 0.43) with a complete response of 56.2% vs 60.8% vs 80.0% (P = 0.85). Early response was achieved in the methylprednisolone group with 3.5 days, versus dexamethasone with 4.0 days and prednisone with 7 days. The sustained response at 6 months was lower in the prednisone group 80.0%. The most frequent adverse events occurred in the HD-DXM group with fatigue in 31.2% (n = 5) followed by edema, hyperglycemia and insomnia with 18.7% (n = 3). Conclusions. Our study demonstrated that PDN provides greater overall responses as initial treatment in ITP. MTP provides the fastest responses followed by HD-DXM. The sustained response was maintained in the HD-DXM Group. The HD-DXM group presented 68.7% cases with at least one adverse event associated with the use of the steroid. The findings suggest continuing to perform more studies in our population.

Scalp atrophy secondary to steroid use in patients with scarring alopecia: are topical steroids superior to topical calcineurin inhibitors?

Scalp atrophy secondary to steroid use in patients with scarring alopecia: are topical steroids superior to topical calcineurin inhibitors?

Surgical Treatment of Secondary Pneumothorax-Complicated Interstitial Lung Disease.

To investigate the feasibility of early surgical treatment and perioperative steroid use in patients with interstitial lung disease (ILD) complicated by pneumothorax. We retrospectively examined data, including patient characteristics, laboratory findings, surgical treatment details, postoperative complications, and deaths, of nine patients with ILD complicated by secondary pneumothorax. The patients had been treated at our hospital during the past 10 years. All nine patients were male (median age, 69.0 years). A total of nine patients had a histopathologic diagnosis of ILD after surgery. Of these, five were clinically diagnosed with ILD before surgery. Collagen disease was diagnosed in one case, drug-induced in one case, and idiopathic ILD (IILD) in three cases. All nine patients were diagnosed with postoperative ILD, including one case of collagen disease, one case of drug-induced, three cases of idiopathic pulmonary fibrosis (IPF)/cryptogenic fibrosing alveolitis, one case of nonspecific interstitial pneumonia (NSIP), and three cases of cryptogenic organizing pneumonia (COP). Regarding preoperative clinical characteristics, the performance status (PS) was 0 or 1 in all patients. Overall, three patients received oxygen (0-3 L/min), whereas steroids were administered to five patients. The mean drainage period was 23.5 days, and this was consistent with the time taken from pneumothorax occurrence to surgery. Video-assisted thoracic surgery (VATS) and thoracoscopic-assisted surgery were performed in seven and two patients, respectively. No postoperative recurrence or surgery-related deaths occurred. Early surgery for secondary pneumothorax complicated by ILD may be a viable option for patients in good preoperative condition. For patients who are preoperatively treated with steroids, continued use of steroids should be carefully considered.

Risk factors affecting outcome of rhino-orbital-cerebral mucormycosis in COVID-19 patients

BackgroundMucormycosis is a serious life-threatening fungal infection that recently made severe sudden and devastating surge during the second wave of the COVID-19 epidemic with a mortality rate of up to 50%.Although the causality link between COVID-19 and rhino-orbito-cerebral mucormycosis (ROCM) remains unclear, many factors including poor diabetes control, high doses of steroids, viral-induced lymphopenia, and cytokine storm have been attributed to ROCM in patients with COVID-19.Orienting to risk factors and early recognition of this potentially fatal opportunistic infection is the key to optimal management and improved outcomes. In these contexts, we conducted a prospective study for 33 patients admitted to our tertiary hospital to determine the risk factors for ROCM in patients with COVID-19 and the cumulative mortality rates.ResultsThis study found a statistically significant relation between the fate of death in COVID-MUCOR patients who had presented fever, ophthalmoplegia, facial skin necrosis, and visual loss with those who received dose of steroid to control their respiratory symptoms P < 0.001.Death from COVID-MUCOR was statistically significant related to the prolonged interval from the onset of the symptoms to start of treatment and intervention. Also, it was found that there was a significant decrease in duration between COVID-19 infection and the start of mucormycosis (days) with incidence of DKA on admission. Nineteen (57.6%) of the patients had uncontrolled diabetes mellitus (hemoglobin A1C (HbA1c) of > 7.0%).ConclusionMucormycosis epidemic was precipitated by a unique confluence of risk factors: diabetes mellitus, widespread use of steroids, and perhaps SARS-CoV-2 infection itself. Restricting steroid use in patients with severe COVID-19 requiring oxygen therapy, and screening for and optimally controlling hyperglycemia, can prevent COVID-MUCOR in a large majority.

Quality of Life (QoL) in Patients with Chronic Inflammatory Bowel Diseases: How Much Better with Biological Drugs?

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic and disabling diseases that affect patient health-related quality of life (HRQoL). IBD patients are frequently exposed to high levels of stress and psychological distress. Biological drugs have been proven to reduce inflammation, hospitalization, and most of the complications that characterize IBDs; their potential contribution to patients' HRQoL remains to be explored. To evaluate and compare any change in the HRQoL and markers of inflammation in IBD patients undergoing biological drugs (infliximab or vedolizumab). A prospective observational study was conducted on a cohort of IBD patients, aged >18 years, who were prescribed with infliximab or vedolizumab. Demographic and disease-related data at baseline were collected. Standard hematological and clinical biochemistry parameters, including C-reactive protein (CRP), white blood cells count (WBC), erythrocytes sedimentation rate (ESR), and α1 and α2 globulins were measured after a 12-h fast at baseline (T0), after 6 weeks (T1), and at 14 weeks (T2) of biological treatment. Steroid use, disease activity as measured by the Harvey-Bradshaw index (HBI) and partial Mayo score (pMS) for the CD and UC, respectively, were also recorded at each timepoint. The Short Form 36 Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT-F), and Work Productivity and Activity Impairment-General Health Questionnaire (WPAI:GH) were administered to each patient at baseline, T1, and T2 to address the study aims. Fifty eligible consecutive patients (52% with CD and 48% with UC) were included in the study. Twenty-two patients received infliximab and twenty-eight received vedolizumab. We noted a significant reduction in the CRP, WBC, α1, and α2 globulins from T0 to T2 (p = 0.046, p = 0.002, p = 0.008, and p = 0.002, respectively). Participants showed a significant decrease in steroid administration during the observation period. A significant reduction in the HBI of CD patients at all three timepoints and a similarly significant decrease in the pMS of UC patients from baseline to T1 were recorded. Statistically significant changes were observed in all questionnaires during follow-up as well as an overall improvement in the HRQoL. The interdependence analysis carried out between the biomarkers and the scores of the individual subscales showed a significant correlation between the variation (Δ) of the CRP, Hb, MCH, and MCV with physical and emotional dimensions of the SF-36 and FACIT-F tools; work productivity loss expressed by some of the WPAI:GH items negatively correlated with the ΔWBC and positively with the ΔMCV, ΔMCH, and Δ α1 globulins. A sub-analysis according to the type of treatment showed that patients receiving infliximab experienced a more pronounced improvement in their HRQoL (according to both SF-36 and FACIT-F) compared with patients receiving vedolizumab. Both infliximab and vedolizumab played an important role in contributing to the improvement of the HRQoL in IBD patients by also reducing inflammation and, consequently, steroid use in patients with an active disease. HRQoL, being one of the treatment goals, should also be assessed when taking charge of IBD patients to assess their clinical response and remission. The specific correlation between the biomarkers of inflammation and life's spheres, as well as their possible role as clinical markers of HRQoL, should be further investigated.

Abstract #1413743: New Onset Diabetes and Acute Pancreatitis- A Sequela of Long COVID?

The association between worse COVID-19 outcomes and diabetes has been well-established in the literature. However, with more cases of new-onset diabetes and pancreatitis being reported with or after COVID-19 infection, it poses the question if there is a causal relationship between them. 31 y/o female with COVID-19 infection 4-6 weeks ago with moderate symptoms (not requiring hospital admission or monoclonal ab), presented to ED with bandlike epigastric pain radiating to back, which is worsened with food, associated with nausea, vomiting, polyuria, and fatigue. Workup showed lipase 232, AST 180, ALT 256. Blood glucose was 281 and HbA1c was 12. CT A/P showed post cholecystectomy status, normal pancreas with mesenteric adenitis. MRCP showed hepatic steatosis with trace fluid around the pancreas s/o inflammation, and no evidence of choledocholithiasis or biliary dilatation. She denied alcohol use and autoimmune workup for pancreatitis was unremarkable. Islet cell antibodies were negative. The patient improved with fluid resuscitation and was discharged home on insulin with plans to transition to oral agents outpatient. Long COVID is defined as a range of conditions or symptoms in patients recovering from COVID-19, lasting beyond 4 weeks after infection. A retrospective cohort study showed increased new-onset diabetes incidence in patients after COVID-19. This was redemonstrated in a systematic review and meta-analysis that showed a 14.4% increased proportion of new diagnoses of diabetes in patients hospitalized with COVID-19. Possible pathophysiology that have been attributed to this include undiagnosed pre-existing diabetes, hyperglycemia secondary to acute illness and stress from increased inflammatory markers during the cytokine storm, the effect of viral infections on the pancreas, and concurrent steroid use in patients with severe respiratory disease. The binding of SARS-CoV-2 to ACE2 receptors is thought to the other mechanism by which COVID can cause pancreatitis and hyperglycemia. Study showed increased lipase and amylase levels in patients with COVID and the increase in serum levels was proportional to the severity of the disease. Patients who died due to COVID-19 were also found to have degeneration of the islet cells. While, several studies have showed new onset diabetes and pancreatitis during an active COVID infections, we need larger cohort studies to comment on its true association or causation, especially in patients with long COVID symptoms. As more cases of new onset diabetes and pancreatitis with COVID-19 are being reported, there may be a need for more frequent blood sugar monitoring during the recovery phase of COVID-19.

PATTERNS OF STEROID USE AMONG A REAL-WORLD NATIONAL COHORT OF VETERANS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Corticosteroids are effective in the acute improvement of symptoms in inflammatory bowel disease (IBD) but are not recommended as maintenance therapy due to lack of long-term efficacy and significant adverse effects. Long term goals for medical management in IBD include achieving steroid-free remission. Biologics such as the anti-tumor necrosis factor alpha Infliximab (IFX) are used to achieve clinical remission, however patterns of continued steroid use among patients on maintenance IFX have not been fully studied. The aim of this study is to evaluate patterns of concomitant steroid use in individuals with IBD on maintenance IFX. METHODS We performed a retrospective cohort study using the national Veteran’s Health Administration dataset. Patients with IBD were identified using a previously validated algorithm of ICD9/10 codes and confirmed by manual chart review. Dispensed medications and demographic data were obtained from VA Corporate Data Warehouse. Patients were eligible for inclusion if they had a confirmed diagnosis of IBD and on maintenance IFX. Maintenance IFX- index date was defined as the first dose of IFX in 2017 with receipt of IFX 7 to 9 weeks before and after IFX-index date. The study period for steroid use was six months prior to and following the IFX-index date. Continued steroid use was defined as two or more filled prescription of oral steroids during the study period. RESULTS There were 642 individuals included who met the criteria outlined above. The majority (594, 92.5%) were male. The racial breakdown was as follows: 516 (80.3%) White, 85 (13.3%) Black, 18 (2.8%) other races, and 23 (3.6%) with unknown race. A total of 402 individuals (62.6%) had ulcerative colitis, 240 individuals (37.4%) had Crohn’s disease. The average age at the IFX-index date was 46.8 (±15.8) years. The average time from initial date of IFX exposure to the Maintenance IFX-index date was 3.6 years. During the study period, 198 (30.9%) patients filled at least one prescription for steroids. 145 of the 198 (73.2%) individuals prescribed had continued steroid use with two or more filled steroid prescriptions, with an average of 3.9 filled prescriptions of steroids during the study period. CONCLUSION While IFX has been shown to be effective in the induction and maintenance of remission in IBD, we observe high rates of continued steroid use in a national cohort of patients with IBD on maintenance IFX. Continued steroid use in patients on IFX maintenance implies inadequate IBD control despite IFX. Further study is required to understand reasons for continued steroid use in order to improve rates of steroid-free remission in IBD.

Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis.

Risks of long-term steroid use in patients with ulcerative colitis (UC) outweigh the benefits, thus dosing should be tapered once a response is achieved. Colonoscopy is a key technique for assessing disease severity and optimizing treatment involving steroids. This retrospective longitudinal cohort study of patients with UC explored factors associated with the duration of systemic steroid use. The Japan Medical Data Center database, an employer-based insurance claims database, was used to select individuals initiating prednisolone, with a prescription issued between January 1, 2010, and January 31, 2018. The study included adults with a confirmed diagnosis of UC, who had received ≥1 year of continuous treatment with 5-aminosalicylic acid, biologics, or thiopurine. Factors associated with prednisolone duration were assessed using a multivariate regression model. Median duration of prednisolone treatment was 98 days, and colonoscopy was performed ≤1 month before or at the first prescription of prednisolone (index date) in 32.8% of patients (607/1,853). Shorter durations of prednisolone treatment were associated with colonoscopy ≤1 month before or at the index date and higher prednisolone dose at index date, with incidence rate ratios (IRRs) of 0.776 (95% confidence interval [CI], 0.682-0.884; P<0.001) and 0.998 (95% CI, 0.996-1.000; P=0.018), respectively. Charlson Comorbidity Index scores of 1 and ≥2 predicted longer prednisolone treatment (IRR, 1.332; 95% CI, 1.174-1.511; P<0.001 and IRR, 1.599; 95% CI, 1.357-1.885; P<0.001, respectively). Performing colonoscopy before or at the time of initiating steroid was associated with a shorter duration of steroid use in patients with UC.

1058. Development of a Steroid Stewardship Bundle to tackle the Glucocorticoid-Induced Hyperglycemia in COVID-19 patients: Results of SUPER Diabetes Study.

Abstract Background Glucocorticoid therapy in COVID-19 patients poses a greater risk of hyperglycemia, leading to an unexpected detrimental effect on treatment outcomes. The Steroid Use in Patients Exhibiting Risk (SUPER) to Diabetes -SUPER Diabetes- study aimed to implement a steroid stewardship bundle to encounter the incidence of Glucocorticoid-Induced Hyperglycemia (GCIH) in COVID-19 patients and to evaluate the effectiveness of the Steroid Stewardship Program. Methods This interventional study included 600 COVID-19 confirmed patients admitted between April 2021and March 2022 in a secondary care hospital in India (stewardship cohort). A six-item Steroid Appropriate Index (SAI) assessed the need for steroid therapy using the parameters like the severity of disease, the onset of symptoms, weight of the patient, CT Thorax score, the preferred route of administration, and the comorbid disorders. This created a steroid stewardship bundle with the following parameters: (1) appropriate selection of the corticosteroid; (2) repeat blood sugar monitoring every 8 hours until discharge from hospital; (3) appropriate duration of therapy (4) proper de-escalation of dose/intravenous to oral switch. The patients were followed until discharge/death to track the incidence of hyperglycemia. The analysis of the effectiveness of SAI and the stewardship bundle was done by comparing this with the clinical outcomes among 300 COVID-19 confirmed patients admitted before implementing the scale (retrospective cohort). Results The majority of the patients included in the stewardship cohort were males (367; 61.1%), and the mean age was 47.3± 17.1 years. The incidence of new-onset of hyperglycemia or a worsened glycemic profile, i.e., Glucocorticoid-Induced Hyperglycemia (GCIH), was more among the retrospective cohort when compared with the stewardship cohort (32.1% vs 6.3%), p&amp;lt; 0.001). The study also revealed that history of diabetes (p&amp;lt; 0.001), age (p=0.002), number of medicines used for treatment (p&amp;lt; 0.001), and the frequency of monitoring of diabetes (p&amp;lt; 0.001) are significantly associated with GCIH. Conclusion Implementing the steroid stewardship bundle significantly improved the appropriate selection and use of corticosteroids, decreasing the incidence of associated adverse events. Disclosures All Authors: No reported disclosures.

Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease.

Steroids have long been used in inducing remission of inflammatory bowel disease (IBD). Chronic use, defined as therapy greater than 3 months, has been implicated in complications including increased hospital length of stay (LOS), infections, and even death. In our retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD. The fourth quarter of 2015-2019 National Inpatient Sample (NIS) was used in this study. International Classification of Diseases (ICD-10) codes were used to identify patients with a diagnosis of IBD and chronic steroid use. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. Cohorts were weighted using an algorithm provided by the NIS allowing for accurate national estimates. A total of 283 970 patients had a diagnosis of IBD. Of those, 18 030 patients had concurrent chronic steroid use. Racial disparities existed, with 77.4% White, 12.7% Black, and 6.0% Hispanic. Patients with a history of IBD and chronic steroid use were found to have higher odds of developing osteoporosis, opportunistic infections, and acute thromboembolic events but did not have higher odds of mortality. There is much controversy about whether IBD patients should be on chronic steroids for maintenance therapy and this study highlights the importance of this decision as patients on chronic steroid use had higher odds of developing adverse effects. These results stress the importance of monitoring patients on steroids and avoiding chronic use.

Chronic Steroid Use in Patients Undergoing Liver Resection: Does It Affect Outcomes?

Chronic Steroid Use in Patients Undergoing Liver Resection: Does It Affect Outcomes?

Management of patients on systemic steroids: An oral surgery perspective

Corticosteroids are a common pharmacological treatment option used in a diverse range of clinical conditions. The diversity of guidance on their use has inevitably led to conflicting management plans between dental clinicians. For patients on long-term steroid cover, several guidelines highlight the importance of additional steroid prescribing during ‘stressful’ procedures. However, guidance on the definition of ‘stressful’ varies, as well as the recommended protocols. This article explores the existing evidence regarding steroid cover in patients taking long-term steroids, and proposes a protocol to help manage these patients in the dental environment. CPD/Clinical Relevance: An understanding of the clinical implications of long-term steroid use in patients requiring dental treatment, as well as the appropriate management protocols is important.

The Prevention and Treatment of Nausea and Vomiting During Tumor Therapy.

Nausea and vomiting are common and distressing side effects of tumor therapy. Despite prophylaxis, 40-50% of patients suffer from nausea, and 20-30% from vomiting. Antiemetic prophylaxis and treatment are therefore of great importance for improving patients' quality of life and preventing sequelae such as tumor cachexia. The recommendations presented here are based on international and national guidelines, updated with publications retrieved by a selective search in the PubMed and Cochrane Library databases, with special attention to randomized controlled trials and meta-analyses that have appeared in the past 5 years since the German clinical practice guideline on supportive therapy was published. Risk-adjusted prevention and treatment is based on the identification of treatment-related and patient-specific risk factors, including female sex and younger age. Parenteral tumor therapy is divided into four risk classes (minimal, low, moderate, high), and oral tumor therapy into two (minimal/low, moderate/high). In radiotherapy, the radiation field is of decisive importance. The antiemetic drugs most commonly used are 5-HT3-RA, NK1-RA, and dexamethasone; olanzapine has proven beneficial as an add-on or rescue drug. The use of steroids in patients being treated with drug combinations including checkpoint inhibitors is discussed controversially because of the potentially reduced therapeutic response. Benzodiazepines, dimenhydrinate, and cannabinoids can be used as backup antiemetics. Acupuncture/acupressure, ginger, and progressive muscle relaxation are pos - sible alternative methods. Detailed, effective, risk profile-adapted algorithms for the prevention and treatment of nausea and vomiting are now available for patients undergoing classic chemotherapy regimens or combined radiotherapy and chemotherapy. Optimal symptom control for patients undergoing oral tumor therapy over multiple days in the outpatient setting remains a challenge.

Effect of Cyclophosphamide and Glucocorticoid Therapy in IgA Nephropathy: A Single-Center Retrospective Analysis.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis in adults, which causes ESKD in ≤45% of patients in the long term. The optimal therapeutic approach remains undetermined. In this study, we report the results of a single-center retrospective analysis of patients with IgAN. We retrospectively evaluated the therapeutic approach and outcome of all patients at our center with biopsy-proven IgAN between 2000 and 2020, focusing on the effect of intravenous cyclophosphamide therapy combined with glucocorticoids ("immunosuppressive therapy group"). The control group received standard supportive care. Patients in the immunosuppressive therapy group had worse kidney function before the initiation of therapy, as indicated by higher serum creatinine, more proteinuria, and a higher degree of hematuria than the control group; they also displayed a higher body mass index. The Oxford classification of IgA nephropathy (MEST-C score) suggested more inflammatory activity in the immunosuppressive therapy group, including more crescents and endocapillary hypercellularity. During the follow-up, proteinuria and hematuria decreased in both groups, and to a significantly greater extent in the immunosuppressive therapy group. Cyclophosphamide treatment significantly improved kidney function as determined by the fold-change of eGFR during the observation period. The number of infections and hospitalizations did not differ, but the incidence of diabetes was increased in the immunosuppressive therapy group. This study suggests immunosuppressive therapy with cyclophosphamide combined with glucocorticoids improves kidney function, proteinuria, and hematuria. The therapy was safe for infectious complications, but was associated with an increased incidence of diabetes, which might be attributable in part to the use of steroids in patients with a higher body mass index at baseline. Although immunosuppressive therapy in IgAN remains controversial, our findings suggest that at least some patients benefit from more aggressive therapy.

Physician education can minimize inappropriate steroid use in patients with inflammatory bowel disease: the ACTION study.

Epidemiological data on steroid use in South Korean patients with inflammatory bowel disease (IBD) are limited. We documented the steroid use patterns in these patients, and whether physician education on appropriate steroid use affected these patterns. ACTION was an observational cohort study conducted in adults (≥19 years) with IBD. A retrospective chart review was performed at baseline (cohort 1) and 1 year after physician training (cohort 2). Eligible cases with excessive or inappropriate steroid use were identified, along with any associated risk factors. Data were collected during May 2018-July 2019 from patients with Crohn's disease (CD) and ulcerative colitis (UC) in cohort 1 (n=1,685) and cohort 2 (n=1,649). At baseline, 155 patients (9.2%) had received steroids within the previous 12 months, 46 (29.7%) of whom had used steroids excessively, 16 (34.8%) of these having inappropriately used excessive steroids. Although steroid exposure was similar in cohort 1 (9.2%) and cohort 2 (9.7%), the latter comprised fewer excessive steroid users (20.0% vs. 29.7%). Severe disease was associated with excessive steroid use in cases with UC, but not with CD. Although, overall steroid use was relatively low in South Korean patients with IBD, one-third of steroid users used them excessively, and one-third among these used excessive steroids inappropriately. High disease activity was the main risk factor for excessive steroid use which may potentially be reduced by physician education, especially in cases with UC. Active screening to minimize excessive and inappropriate steroid use through physician education should be considered.

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States.

This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation. Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications. All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.

P537 Steroid use in patients with immune checkpoint inhibitor colitis

Abstract Background Immune checkpoint inhibitors (ICIs) encompass drugs targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4), inhibitors of programmed cell death receptor-1 (PD-1), and inhibitors of programmed cell death ligand 1 (PD-L1) used for the treatment of cancer. Gastrointestinal side effects associated with ICI therapy are among the most common complications. This study aims to review steroid use in patients admitted with ICI colitis. Methods This was a retrospective review of patients in a tertiary center who received ICIs between January 2018 and December 2020 who required admission for the development of ICI colitis. Demographic data, previous and ongoing therapy, laboratory parameters, medical therapy and endoscopic findings were reviewed. Results Of the 545 patients who received ICIs, 4% (22) required admission with ICI colitis. Of those who developed ICI colitis 31.8% (7) were receiving combination ipilimumab and nivolumab, 31.8% (7) were receiving pembrolizumab, 27.3% (6) were receiving nivolumab, 4.5% (1) were receiving cemiplimab and 4.5% (1) were receiving ipilimumab. The median age was 64.5 years (52–75) with the median CTCAE severity score of colitis being 3 (2–3) and the median CTCAE diarrhoea score being 3 (3). On admission, the median stool frequency was 6 (5–8), with median symptom duration of 7 (4–13) days, and median hospital stay of 3 (3–6) days. Laboratory markers were monitored during admission (Table 1). 72% (16) of patients were commenced on intravenous corticosteroid therapy whilst an inpatient, with 95% (21) being discharged on oral prednisolone. Median duration on oral steroid was 22 (8–35) weeks. 36% (8) had oral prednisolone ongoing at the end of the review period. 27% (6) died whilst still on a weaning prednisolone regimen. Conclusion Despite improvement of symptoms during hospital admission with corticosteroid therapy, the majority of patients admitted for ICI colitis required prolonged treatment with corticosteroids.