Timing Of Corticosteroid Administration Research Articles

The Timing of Initiating Hydrocortisone and Long-term Mortality in Septic Shock.

Previous studies on the association between the timing of corticosteroid administration and mortality in septic shock focused only on short-term mortality and produced conflicting results. We performed a retrospective review of a large administrative database of intensive care unit (ICU) patients to evaluate the association between the timing of hydrocortisone initiation and short- and long-term mortality in septic shock. We hypothesized that a longer duration between the first vasopressor use for sepsis and steroid initiation was associated with increased mortality. Data were extracted from the Medical Information Mart in the Intensive Care-IV database. We included adults who met Sepsis-3 definition for septic shock and received hydrocortisone. The exposure of interest was the time in hours from vasopressor use to hydrocortisone initiation (>12 as late and ≤12 as early). The primary outcome was 1-year mortality. Secondary outcomes included 28-day mortality, 90-day mortality, in-hospital mortality, and length of hospital stay. Cox proportional hazard models were used to estimate the association between exposure and mortality. Competing risk regression models were used to evaluate the association between exposure and length of hospital stay. A total of 844 patients were included in this cohort: 553 in the early group and 291 in the late group. The median time to hydrocortisone initiation was 7 hours (interquartile range, 2.0-19.0 hours). After multivariable Cox proportional hazard analysis, we found that hydrocortisone initiation >12 hours after vasopressor use was associated with increased 1-year mortality when compared with initiation <12 hours (adjusted hazard ratio, 1.39; 95% confidence interval, 1.13-1.71; P = .002, E-value = 2.13). Hydrocortisone initiation >12 hours was also associated with increased 28-day, 90-day, and in-hospital mortality and prolonged length of hospital stay. In patients with septic shock, initiating hydrocortisone >12 hours after vasopressor use was associated with an increased risk of both short-term and long-term mortality, and a prolonged length of hospital stay.

Tocolytics for delaying preterm birth: a network meta-analysis (0924).

Tocolytics for delaying preterm birth: a network meta-analysis (0924).

Effect of Systemic Corticosteroid Therapy on the Efficacy and Safety of Nivolumab in the Treatment of Non-Small-Cell Lung Cancer.

Introduction:Corticosteroids are used to treat immune-related adverse events (irAEs) associated with nivolumab. However, patients with non-small-cell lung cancer who are administered corticosteroids before the initiation of nivolumab treatment are commonly excluded from clinical trials. The appropriate timing for corticosteroid administration in relation to nivolumab treatment, effects of corticosteroids on the efficacy of nivolumab, and resulting adverse events are not clearly understood. In this study, the effects of differences in the timing of corticosteroid administration on nivolumab efficacy and the resulting adverse events were examined.Methods:A retrospective study was conducted with 109 patients who were treated with nivolumab at Sapporo Minami-Sanjo Hospital between December 2015 and March 2018.Results:Of the 109 patients treated with nivolumab, 12 patients were administered corticosteroids before the first cycle of nivolumab (pre-CS), and 33 patients were administered corticosteroids after the first cycle of nivolumab (post-CS). These 2 groups were compared with the control group comprising 64 patients who were not administered corticosteroids (non-CS). The objective response rate in the post-CS group was significantly higher than that in the non-CS group, and the disease control rate in the pre-CS group was significantly lower than that in the non-CS group. The overall survival time and progression-free survival time in the pre-CS group were significantly shorter than those observed in the non-CS group; however, these did not differ from those in the post-CS group.Conclusions:These results suggest that corticosteroids administered to patients with non-small-cell lung cancer after initiation of nivolumab treatment did not affect the disease prognosis. Thus, corticosteroids can be administered immediately for rapid treatment of irAEs.

Do corticosteroids reduce postoperative pain following third molar intervention?

BackgroundCorticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery.MethodsThe Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted.ResultsTwenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration.ConclusionsCorticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.

Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?

Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood. This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticosteroids and the evidence of potential harm to offspring are also summarised. Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recommended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal. Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.

Risk of Neonatal Sepsis with Rescue Steroids in Preterm Premature Rupture of Membranes versus Intact Membranes [25F

INTRODUCTION: Currently there is insufficient evidence to make a recommendation for rescue steroids in women with preterm premature rupture of membranes (PPROM). Prior studies have suggested an increased risk of neonatal sepsis and studies investigating rescue steroids excluded these patients. The objective of our study was to compare the rate of neonatal sepsis after rescue steroids in women with PPROM compared to intact membranes. METHODS: We performed a retrospective cohort study of singleton gestations 23.0 to 34.0 weeks, who received rescue corticosteroids at our institution between January 2009 and October 2016. Patients were separated into three groups based on membrane status at the time of corticosteroid administration; Group 1 (intact at initial course/intact at rescue course), Group 2 (intact at initial course/PPROM at rescue course), and Group 3 (PPROM at initial course/PPROM at rescue course). The primary outcome, neonatal sepsis, was compared between the three groups. Patient characteristics and neonatal outcomes were analyzed with Fisher’s exact test and Anova. RESULTS: 143 women were eligible. Neonatal sepsis occurred in 6.8% (7/103) of patients in Group 1, 21.1% (4/19) of patients in Group 2, and 23.8% (5/21) of patients in Group 3 (p 0.021). The relative risk of neonatal sepsis after a rescue course of steroids was 3.31 (95% CI= [1.32, 8.29]) for patients with PPROM (Group 2 and Group 3) compared to those with all intact membranes (Group 1). CONCLUSION: A rescue course of corticosteroids in PPROM was associated with an increased rate of neonatal sepsis. Larger studies are needed to further investigate this association.

Progesterone as a tocolytic agent for preterm labor: a systematic review

Tocolytic agents have been used for over 60 years in the fight against preterm labor, which ultimately can lead to preterm birth. Currently, clinicians can choose from a variety of drug classes to achieve the primary goal of delaying delivery by 48 h, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. However, there are currently no known therapies to maintain the tocolytic effect beyond those initial 48 h. Progesterone, which has been used in the prevention of preterm birth for over 10 years, has long been known to have the effect of uterine quiescence. It was first studied as a tocolytic agent in the 1960s. In the last several years, more studies have been done that suggest a potential use for maintenance tocolysis after the successful arrest of preterm labor. Although the studies are conflicting, the meta-analyses on progesterone show some promise in different outcomes of delayed delivery, reduced incidence of preterm birth, and reduced neonatal morbidity. Progesterone is currently the most promising agent for maintenance tocolysis. Although further trials are certainly needed, this is an exciting advancement in the realm of tocolysis.

Tocolysis for Acute Preterm Labor: Where Have We Been, Where Are We Now, and Where are We Going?

Tocolytics have been used for over 60 years for women with preterm labor, which ultimately can lead to preterm birth (PTB). Diagnosing preterm labor is challenging, but use of objective tests such as transvaginal ultrasound of cervical length assists in the identification of women at the highest risk for PTB. Once preterm labor has been diagnosed, clinicians can choose from a variety of drug classes (cyclooxygenase inhibitors, calcium channel blockers, and betamimetics) to achieve the primary goal of delaying delivery by 48 hours, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. Cyclooxygenase inhibitors are the only class of tocolytics proven to decrease PTB < 37 weeks. Knowledge of the safety and effectiveness of these medications is paramount. Several additional agents (e.g., oxytocin receptor antagonists) have significant promise, but further studies are required before these medications can be approved for tocolysis in the United States. As we look into the future of tocolysis, we anticipate that deeper understanding of the complex physiology of preterm labor will allow us to uniquely target different etiologies that lead to the final path resulting in spontaneous preterm delivery.

Clinical characteristics and corticosteroid therapy in patients with autoimmune-hepatitis-induced liver failure.

To investigate the clinical features, response to corticosteroids, and prognosis of autoimmune hepatitis (AIH)-induced liver failure in China. A total of 22 patients (19 female and 3 male; average age 51 ± 15 years) with AIH-induced liver failure treated in our hospital from 2004 to 2012 were retrospectively analyzed. Clinical, biochemical and pathological characteristics of the 22 patients and responses to corticosteroid treatment in seven patients were examined retrospectively. The patients were divided into survivor and non-survivor groups, and the clinical characteristics and prognosis were compared between the two groups. The t test was used for data analysis of all categorical variables, and overall survival was calculated by the Kaplan-Meier method. At the time of diagnosis, mean IgG was 2473 ± 983 mg/dL, with three (18.8%) patients showing normal levels. All of the patients had elevated serum levels of antinuclear antibody (≥ 1:640). Liver histology from one patient showed diagnostic pathological changes, including massive necrosis and plasma cell infiltration. Four patients survived (18.2%) and 18 died (81.8%) without liver transplantation. The results showed that patients with low admission Model for End-Stage Liver Disease (MELD) scores (21.50 ± 2.08 vs 30.61 ± 6.70, P < 0.05) and corticosteroid therapy (100% vs 16.7%, P < 0.05) had better prognosis. A total of seven patients received corticosteroid therapy, of whom, four responded and survived, and the other three died. Survivors showed young age, shorter duration from diagnosis to corticosteroid therapy, low MELD score, and absence of hepatic encephalopathy at the time of corticosteroid administration. Six patients who were administered corticosteroids acquired fungal infections but recovered after antifungal therapy. Early diagnosis and corticosteroid therapy are essential for improving the prognosis of patients with AIH-induced liver failure without liver transplantation.

Corticosteroids for the prevention of bronchopulmonary dysplasia in preterm infants: an overview of Cochrane reviews

AbstractBackgroundBronchopulmonary dysplasia (BPD) is an important complication associated with considerable morbidity in preterm infants. Corticosteroids in various regimens have been tried out to prevent BPD.ObjectiveTo examine the evidence from Cochrane systematic reviews regarding the effectiveness and associated complications of corticosteroids used to prevent BPD in preterm infants.MethodsThe Cochrane Database of Systematic Reviews was searched to identify reviews of corticosteroids for BPD in preterm infants. Data were extracted by one investigator, and checked by a second investigator for accuracy. Results are presented as risk ratios (RR) with 95% confidence intervals (CI). We considered &lt;8 days as early and &gt;7 days as late administration.Main resultsSix reviews (67 trials and 6535 patients) were included and covered three main comparisons: inhaled corticosteroids versus placebo, inhaled versus systemic corticosteroids and systemic corticosteroids versus placebo. Systemic corticosteroids compared with placebo significantly reduced the incidence of BPD (early: RR 0.79, 95% CI 0.71–0.88; late: RR 0.72, 95% CI 0.63–0.82), and BPD or mortality (early: RR 0.89, 95% CI 0.84–0.95; late: RR 0.72, 95% CI 0.63–0.82) at 36 weeks post‐menstrual age. Similar results were observed for these outcomes assessed at 28 days of life at which time there was additionally a reduction in mortality (late: RR 0.49, 95% CI 0.28–0.85). There was a higher incidence of cerebral palsy associated with systemic corticosteroids compared with placebo when initiated early (RR 1.45, 95% CI 1.06–1.98). No differences in neurodisability based on Bayley Mental or Psychomotor Developmental Index scores were observed for inhaled or systemic corticosteroids compared with placebo. Hypertension was significantly increased in association with systemic corticosteroids versus placebo (early: RR 1.85, 95% CI 1.55–2.22; late: RR 2.66, 95% CI 1.58–4.49) as were gastrointestinal (GI) perforations when treatment was initiated early (RR 1.81, 95% CI 1.33–2.48).Author's ConclusionSystemic corticosteroids decrease BPD and early mortality in premature infants but have a risk of complications, particularly when initiated in the first week of life. Owing to the wide range of dosing protocols, timing of initiation, doses and duration of therapy in the included reviews, it is difficult to determine, based on the evidence examined in this overview, a protocol that is both safe and effective. Further research should focus on determining the most effective dose and timing of corticosteroid administration beyond the first week of life to maximize benefit in decreasing BPD and mortality while avoiding short‐ and long‐term harms.

Corticosteroid Timing and Length of Stay for Children With Asthma in the Emergency Department

To determine if early treatment with oral corticosteroids to pediatric patients with asthma exacerbations in the emergency department could decrease their length of stay.Children between the ages of 2 and 18 years who presented to the emergency department with acute asthma exacerbations and received oral corticosteroids, either prednisolone or dexamethasone, were included.Retrospective chart review of 882 children who were seen over the 12-month study period was performed. A standardized asthma treatment algorithm was used as a guide based on severity of exacerbation, but the treating physician decided medications used. Timing of corticosteroid administration and length of stay was calculated by the electronic medical record. Children receiving corticosteroids within 60 minutes of triage were compared with those receiving corticosteroids ≥61 minutes after triage. The 2 groups were compared using either Student’s t test or χ2 test, based on the level of measurement.Children treated with corticosteroids within 60 minutes had a mean length of stay of 157 minutes, whereas children treated later than 60 minutes had a mean length of stay of 182 minutes (P < .0001). The greatest decrease in length of stay was among children who were categorized as having a moderate exacerbation and had a mean 38-minute decrease in length of stay if treated with corticosteroids in the first hour. Both study groups had similar baseline characteristics; however, the group receiving corticosteroids within 60 minutes had a higher percentage of severe exacerbations. Subjects who received dexamethasone had a 19-minute shorter length of stay compared with patients treated with prednisolone. Of the subjects treated with dexamethasone, those who received it in the first 60 minutes had a mean 34-minute decrease in length of stay compared with those treated with prednisolone. Early treatment with albuterol within 60 minutes or after did not affect length of stay.Early corticosteroid administration within 60 minutes of triage in pediatric patients with asthma exacerbations was associated with a significant decrease in the overall length of stay. This study suggested that choice of oral corticosteroid, dexamethasone over prednisolone, may also affect the length of stay.Previous studies have found early corticosteroid administration to lessen admission rates to the hospital. Although this study did not show a difference in admission rates, this study did support early corticosteroid administration within the emergency department to help lessen length of stay. Properties of dexamethasone make it appear superior to prednisolone, but prospective randomized trials are necessary, as previous studies did not show significant improvements for decrease in length of stay or in admissions. As treatment protocols become more common, a prospective study that validates early use of oral corticosteroids and choice of oral steroid may help to both lessen the length of stay and decrease hospital admissions for asthma exacerbations. A limitation of this study was that type of oral steroid medication and other asthma medication use was left to the discretion of the treating physician, which may affect length of stay as well.

Glucocorticoids in Rheumatoid Arthritis

Interest in the numerous benefits of corticosteroid medication in the management of rheumatoid arthritis (RA) goes back to the mid-1950s, and has recently been renewed. The established evidence of their rapid symptomatic effects, along with the growing recognition of their long-lasting disease-modifying properties and preliminary data about their sub-clinical action, led us to reconsider the potential of corticosteroids in the treatment of RA, given their acceptable safety profile, especially when used at low dosages. Over time, several corticosteroid-based therapeutic approaches have been explored in order to optimize their clinical benefits, while limiting the adverse effects. Clinical data reported with initial high-dosage corticosteroid schedules with subsequent step-down schemes suggest clinical efficacy, but are not applicable to patient management in a real-life setting. Encouraging results on the clinical and sub-clinical effects of low dosages have led to a shift in usual daily practice. We present past and recent efforts to clarify the role of corticosteroids in the treatment of RA, focusing on the best approach in terms of dose and timing of corticosteroid administration. Additional information about different routes of administration, step-down schedules and adverse effects are also considered.

Corticosteroid Timing and Length of Stay for Children with Asthma in the Emergency Department

Objective. The aim of this study was to evaluate the relationship between time of corticosteroid administration to children with asthma exacerbations in the Emergency Department (ED) and length of stay (LOS). We hypothesized administration within 60 minutes would be associated with a 10- minute or greater decrease in mean LOS. Methods. A retrospective chart review of 882 patients was conducted. Children between the ages of 2 and 18 years presented to the Connecticut Children’s Medical Center’s (CCMC’s) ED with an acute asthma exacerbation were included. Children were excluded if they did not receive oral corticosteroids in the ED, had significant co-morbidities, were currently taking corticosteroids, or had taken them within the past 7 days. Children receiving corticosteroids within 60 minutes of triage were compared with children receiving corticosteroids for 61 minutes or later. The primary outcome was mean LOS. Results. Children treated with corticosteroids within 60 and 61 minutes or later had similar age, gender, insurance, and disposition. Children treated with corticosteroids within 60 minutes had a 25-minute decrease in LOS compared with children treated for 61-minute or later (95% CI: 15–35), p < .0001. Conclusions. Administering corticosteroids to pediatric asthma patients in the ED within an hour of triage is associated with a 25-minute mean decrease in LOS. With large numbers of asthma visits, a 25-minute decrease in LOS for each child could have a significant impact on patient throughput in the ED.

Erratum: Age at time of corticosteroid administration is a risk factor for osteonecrosis in pediatric patients with systemic lupus erythematosus: A prospective magnetic resonance imaging study

In the article by Nakamura et al in the February 2010 issue of Arthritis & Rheumatism (pages 609–615), the mean ± SD highest daily corticosteroid dose according to body weight in subjects without osteonecrosis was reported incorrectly (line 32 of the left column on page 613). The correct value in this group was 1.2 ± 0.3 mg/kg/day. We regret the error.

Clinicopathological features of severe and fulminant forms of autoimmune hepatitis

Diagnosis of the acute presentation of autoimmune hepatitis (AIH) is difficult because patients do not always show typical clinicopathological features of AIH. Although some of them progress to fulminant hepatitis, the survival rate of which is <20% without liver transplantation, their clinicopathological features have remained uncertain. We examined them for a better understanding and improvement of the prognosis of "life-threatening" severe and fulminant AIH. Clinical, biochemical and pathological features of 28 patients with severe or fulminant AIH and treatment responses were examined retrospectively. At the time of admission, mean immunoglobulin G was 2479 ± 1170 mg/dl, with 7 (25%) patients showing normal levels. Anti-nuclear antibody was ≤ 1:40 in 8 (29%). Liver histology showed severe activity in 95% and acute hepatitis in 86% of the patients. Centrilobular necrosis including submassive and massive necrosis was characteristic. Of the 25 patients treated with corticosteroids, 17 responded and 8 did not. Responders to corticosteroids showed younger age and higher prothrombin time (PT) activity than non-responders at the time of corticosteroid administration. The improvement of PT activity during 2 weeks and 4 weeks and total bilirubin level during 4 weeks was statistically significant in responders, but not in non-responders. We should diagnose and treat acute onset AIH patients before they develop into severe and fulminant disease. Performing liver biopsy at the early stage of acute onset AIH, evaluating the biopsy specimens precisely and initiating corticosteroid therapy may be essential for improving the prognosis without liver transplantation.

Age at time of corticosteroid administration is a risk factor for osteonecrosis in pediatric patients with systemic lupus erythematosus: A prospective magnetic resonance imaging study

To clarify whether age at the time of the initial administration of corticosteroids is a risk factor for corticosteroid-associated osteonecrosis in children with systemic lupus erythematosus (SLE), using magnetic resonance imaging (MRI). From 1986 to 2007, MRI was used to prospectively study 676 joints, including 72 joints (36 hips and 36 knees) in 18 pediatric patients with SLE (<15 years old), 100 joints (50 hips and 50 knees) in 25 adolescent patients with SLE (15-20 years old), and 504 joints (252 hips and 252 knees) in 126 adult patients with SLE (>20 years old), beginning just after corticosteroid administration, for at least 1 year. The followup rate was 100%. In pediatric patients, osteonecrosis developed in 4 joints (6%; all hips). In adolescent patients, osteonecrosis developed in 49 joints (49%; 18 hips and 31 knees). In adult patients, osteonecrosis developed in 207 joints (41%; 95 hips and 112 knees). The rate of osteonecrosis was significantly lower in pediatric patients than in adolescent or adult patients (P = 0.0001). Logistic regression analysis revealed that adolescent and adult patients had a significantly higher risk for osteonecrosis compared with pediatric patients, with an odds ratio of 10.3 (P < 0.0001). The youngest patients with osteonecrosis in the hip and knee were 14.9 years old and 15.5 years old, respectively. Osteonecrosis did not develop in patients younger than age 14 years. Our results suggest that age at the time of the initial administration of corticosteroids is associated with osteonecrosis in pediatric patients with SLE.

Cyclosporine, methotrexate, and methylprednisolone compared with cyclosporine and methotrexate for the prevention of graft-versus-host disease in bone marrow transplantation from HLA-identical sibling donor: a prospective randomized study

AbstractThe role of corticosteroids in the prophylaxis of graft-versus-host disease (GVHD) is not well established. We have conducted a prospective, randomized, open-label, single-center study about the effect of adding methylprednisolone (MP) to the widely used prophylactic regimen consisting of cyclosporine A and methotrexate. A total of 108 consecutive patients treated with allogeneic bone marrow transplantation from an HLA-identical sibling donor for malignant blood disease were entered into the study; 53 patients were randomized to receive and 55 were randomized not to receive prophylactic MP. The dose of MP was 0.5 mg/kg on days 14 to 20, 1 mg/kg on days 21 to 34, 0.5 mg/kg on days 35 to 48, and thereafter the dose was slowly tapered and the administration discontinued on day 110. In the group given prophylactic MP, the incidence of acute GVHD was lower (19% vs 56%,P = .0001), there was a trend toward a lower incidence of chronic GVHD among low-risk patients (P = .06), and during the first 4 months the time spent at hospital was shorter and there were fewer infections. The total amount of MP given was similar in the study groups because of a higher incidence of acute GVHD and its treatment in the group of patients not given prophylactic MP. There were no significant differences between the study groups in relapse rate or survival. In conclusion, the addition of MP to the combination of cyclosporine and methotrexate markedly reduced the incidence of acute GVHD without causing untoward effects. The timing of corticosteroid administration is probably important for the efficacy.

Cyclosporine, methotrexate, and methylprednisolone compared with cyclosporine and methotrexate for the prevention of graft-versus-host disease in bone marrow transplantation from HLA-identical sibling donor: a prospective randomized study

The role of corticosteroids in the prophylaxis of graft-versus-host disease (GVHD) is not well established. We have conducted a prospective, randomized, open-label, single-center study about the effect of adding methylprednisolone (MP) to the widely used prophylactic regimen consisting of cyclosporine A and methotrexate. A total of 108 consecutive patients treated with allogeneic bone marrow transplantation from an HLA-identical sibling donor for malignant blood disease were entered into the study; 53 patients were randomized to receive and 55 were randomized not to receive prophylactic MP. The dose of MP was 0.5 mg/kg on days 14 to 20, 1 mg/kg on days 21 to 34, 0.5 mg/kg on days 35 to 48, and thereafter the dose was slowly tapered and the administration discontinued on day 110. In the group given prophylactic MP, the incidence of acute GVHD was lower (19% vs 56%,P = .0001), there was a trend toward a lower incidence of chronic GVHD among low-risk patients (P = .06), and during the first 4 months the time spent at hospital was shorter and there were fewer infections. The total amount of MP given was similar in the study groups because of a higher incidence of acute GVHD and its treatment in the group of patients not given prophylactic MP. There were no significant differences between the study groups in relapse rate or survival. In conclusion, the addition of MP to the combination of cyclosporine and methotrexate markedly reduced the incidence of acute GVHD without causing untoward effects. The timing of corticosteroid administration is probably important for the efficacy.

Timing of corticosteroid administration important in RA?

Timing of corticosteroid administration important in RA?